Cost-Effectiveness of Urinary Biomarker Panel in Prostate Cancer Risk Assessment

J Urol. 2018 Dec;200(6):1221-1226. doi: 10.1016/j.juro.2018.07.034. Epub 2018 Aug 29.


Purpose: SelectMDx (MDxHealth®) is a panel of urinary biomarkers used in conjunction with traditional risk factors to individualize risk prediction for clinically significant prostate cancer. In this study we sought to characterize the effectiveness of SelectMDx in a population of American men with elevated prostate specific antigen.

Materials and methods: We developed a Markov decision analytical model to simulate the chain of events and downstream outcomes associated with ultrasound guided prostate biopsy and a strategy in which the biomarker panel is implemented prior to biopsy. The primary outcome was health outcomes, measured in QALYs (quality-adjusted life years). The secondary outcome was health care costs from the Medicare payer perspective. Multiple 1-way sensitivity analyses were performed to characterize model robustness.

Results: The expected mean QALYs per patient under the current standard was 10.796 at a cost of $11,060 during an 18-year horizon. Incorporating the urinary biomarker panel resulted in an expected mean of 10.841 QALYs per patient and a mean cost of $9,366, representing an average of 0.045 QALYs gained at a cost savings of $1,694 per patient. When extrapolating these data to a conservative estimate of 311,879 men per year undergoing biopsy, one would expect that the biomarker panel would result in an incremental 14,035 QALYs gained at a cost savings of $528,323,026 in each yearly cohort. The biomarker panel strategy dominated the current standard across a wide range of sensitivity analyses.

Conclusions: Routine use of the SelectMDx urinary biomarker panel to guide biopsy decision making improved health outcomes and lowered costs in American men at risk for prostate cancer. This strategy may optimize the value of prostate cancer risk assessment in an era of increasing financial accountability.

Keywords: biomarkers; early detection of cancer; mass screening; prostatic neoplasms; tumor; urine.

MeSH terms

  • Biomarkers, Tumor / analysis
  • Biomarkers, Tumor / economics*
  • Biomarkers, Tumor / urine
  • Clinical Decision-Making
  • Cohort Studies
  • Cost Savings
  • Cost-Benefit Analysis*
  • Decision Support Techniques*
  • Health Care Costs*
  • Humans
  • Image-Guided Biopsy / economics
  • Image-Guided Biopsy / methods
  • Male
  • Markov Chains
  • Medicare / economics
  • Models, Economic
  • Prostate / pathology
  • Prostatic Neoplasms / diagnosis*
  • Prostatic Neoplasms / economics
  • Prostatic Neoplasms / pathology
  • Prostatic Neoplasms / urine
  • Quality-Adjusted Life Years
  • Risk Assessment / economics
  • Risk Assessment / methods
  • Ultrasonography, Interventional / economics
  • Ultrasonography, Interventional / methods
  • United States


  • Biomarkers, Tumor