Transperineal prostate biopsy under local vs general anaesthesia: a cost-effectiveness analysis

Abstract

Objectives

To estimate the cost effectiveness of local anaesthetic (LA) transperineal prostate biopsy (TPB) compared to general anaesthetic (GA) TPB, considering both hospital/health system and societal perspectives.

Patients and Methods

Individual-patient data from a prospective pilot study of 80 patients who underwent LA (n = 40) or GA (n = 40) TPB according to patient preference was used. A cost-effectiveness analysis was conducted using a decision tree model considering cancer detection rates, perioperative and return to work considerations between LA and GA TPB. The economic model included costs associated with consumables, device (capital, maintenance) and personnel for each approach. Cost-effectiveness was evaluated in terms of the incremental cost/quality-adjusted life-years (QALYs) and incremental net monetary benefit. Probabilistic and one-way sensitivity analyses were performed.

Results

Clinical parameters were generally similar between groups, including overall (55%) and significant (35% vs 23%; P = 0.32) cancer detection and procedure-specific duration (20 vs 21 min; P = 0.53). Total procedure and recovery durations were longer in the GA group by 8 min (P < 0.001) and 32.5 min (P < 0.001), respectively. Participants in the LA group returned to work earlier than the GA group (2 vs 4 days; P = 0.046). There was a marginal gain in QALYs between the LA and GA groups (0.82385 vs 0.82383), but LA TPB had lower costs (Australian dollars [AU$]715.80 vs AU$1673.58), with an estimated average cost savings of ~AU$959. From the societal perspective, driven by the reduction in productivity loss, the average cost savings with LA TPB were ~AU$1639. Sensitivity analyses showed the probability of LA being cost effective was 100%, while utilisation of operating theatre for GA TPB was the main driver of cost difference.

Conclusion

Performing TPB via the LA approach would be cost-saving from both hospital and societal perspectives without reducing the accuracy of the biopsy.