{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T22:29:12Z","timestamp":1791584952917,"version":"4.3.4"},"reference-count":36,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Prostate-specific membrane antigen positron emission tomography (PSMA-PET), a form of molecular imaging, increases detection of advanced and metastatic prostate cancer, but its potential to increase treatment costs due to increased detection is poorly defined.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To estimate lifetime health and cost outcomes and evaluate the cost-effectiveness associated with implementing PSMA-PET in the clinical evaluation of a patient with a biochemical recurrence (BCR) of prostate cancer, with evaluation of sources of uncertainty in the underlying evidence and assessment of the need and focus of additional data collection.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This economic evaluation developed a decision-analytic model consisting of a decision tree and a Markov model informed by published literature and a study of patients with BCR prostate cancer undergoing PSMA-PET after definitive surgery or radiation therapy at 2 high-volume US academic centers. The analysis was performed between August 1, 2024, and May 1, 2025.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Patients underwent (1) PSMA-PET, (2) PSMA-PET imaging as a reflex test if computed tomography plus bone scan (CTBS) was negative or equivocal (CTBS\u2009+\u2009PSMA-PET), and (3) CTBS alone.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Lifetime quality-adjusted life-years (QALYs) and costs, incremental cost-effectiveness ratio (ICER), and value of information estimates were assessed, with 95% uncertainty intervals (UIs). We assumed a willingness-to-pay threshold of $150\u202f000 per QALY.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The model simulated 1000 patients with BCR (median age, 66 years) and estimated that up-front PSMA-PET is expected to have the highest mean QALYs (7.12 QALYs [95% UI, 6.71-7.51 QALYs]) compared with 6.55 QALYs (95% UI, 6.08-7.03 QALYs) for CTBS; it was also estimated to have higher mean costs ($451\u202f000 [95% UI, $336\u202f000-$577\u202f000]) compared with $351\u202f000 (95% UI, $263\u202f000-$455\u202f000]) for CTBS; consequently, PSMA-PET had mean increments of $99\u202f000 (95% UI, $55\u202f000-153,000) in costs and 0.58 QALYs (95% UI, 0.35-0.82 QALYs) compared with CTBS, leading to an ICER of $172\u202f000 per QALY, which exceeded the assumed $150\u202f000\/QALY willingness-to-pay threshold. In patients with lower prostate-specific antigen levels (&amp;lt;2 ng\/mL), PSMA had mean increments of $61\u202f000 (95% UI, $21\u202f000-$104\u202f000) in costs and 0.54 QALYs (95% UI, 0.34-0.77 QALYs) compared with CTBS, leading to an ICER of $113\u202f000\/QALY, suggesting it had the potential to be cost-effective. Because of high decisional uncertainty, additional information regarding outcomes and diagnostic characteristics may be associated with reduced uncertainty and a gain of 15\u202f747 QALYs.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This study found that PSMA-PET may be associated with improved disease detection but may not be cost-effective due to high treatment costs offsetting moderate improvements in QALYs. Further research is needed to identify patient subsets and clinical scenarios in which molecular imaging provides the greatest value.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.39250","type":"journal-article","created":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T15:30:36Z","timestamp":1761319836000},"page":"e2539250","source":"Crossref","is-referenced-by-count":7,"title":["Cost-Effectiveness and Evidence Gaps Surrounding PSMA-PET for Recurrent Prostate Cancer Evaluation"],"prefix":"10.1001","volume":"8","author":[{"given":"Natalia","family":"Kunst","sequence":"first","affiliation":[{"name":"Centre for Health Economics, University of York, York, United Kingdom"},{"name":"Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School, of Medicine, New Haven, Connecticut"},{"name":"Department of Medicine, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica B.","family":"Long","sequence":"additional","affiliation":[{"name":"Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School, of Medicine, New Haven, Connecticut"},{"name":"Department of Medicine, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preston C.","family":"Sprenkle","sequence":"additional","affiliation":[{"name":"Department of Urology, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac Y.","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Urology, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence","family":"Saperstein","sequence":"additional","affiliation":[{"name":"Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Rabil","sequence":"additional","affiliation":[{"name":"Department of Urology, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umar","family":"Ghaffar","sequence":"additional","affiliation":[{"name":"Department of Urology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. 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