{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T06:04:55Z","timestamp":1784181895228,"version":"3.55.0"},"reference-count":24,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJUI Compass"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Prostate\u2010Specific Membrane Antigen Positron Emission Tomography Computed Tomography (PSMA PET\/CT) has shown a higher diagnostic accuracy in prostate cancer imaging when compared to conventional modalities, with improved sensitivity and specificity rates when combined with multiparametric prostate Magnetic Resonance Imaging (mpMRI). We evaluated the cost\u2010effectiveness of a combined PSMA PET\/CT and mpMRI biopsy\u2010free diagnostic approach for clinically significant prostate cancer (csPCa).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>A decision tree model was designed to compare two diagnostic strategies for csPCa in men with raised Prostate Specific Antigen (PSA)\u2014the first with conventional mpMRI followed by transperineal prostate biopsy versus a second biopsy\u2010free, PSMA PET\/CT plus mpMRI combined imaging strategy. We evaluated the impact of each strategy on costs and Quality\u2010Adjusted\u2010Life\u2010Years (QALYs). Willingness\u2010to\u2010pay thresholds were set at 1\u00d7 and 3\u00d7 Gross Domestic Product (GDP). One\u2010way sensitivity analysis and probabilistic sensitivity analyses were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A combined mpMRI and PSMA PET\/CT diagnostic strategy was 0.04 QALY more effective but SGD$4088.03 more expensive than the conventional mpMRI and biopsy strategy. The incremental cost\u2010effective ratio (ICER) was SGD$92782.87 per quality\u2010adjusted life year (QALY). In the combined imaging strategy, 3.5% of the cohort had a missed diagnosis of prostate cancer versus 13.9% in the conventional mpMRI and biopsy strategy. Probabilistic analyses showed that the combined imaging strategy was cost\u2010effective at willingness\u2010to\u2010pay thresholds of SGD$121160 and SGD$363480, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Combined mpMRI and PSMA PET\/CT for csPCa diagnosis are a cost\u2010effective strategy in terms of health utility over the conventional approach for diagnosing csPCa in men with raised PSA, potentially reducing the need for invasive diagnostic procedures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/bco2.70172","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T20:47:01Z","timestamp":1770238021000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost\u2010effectiveness analysis of a biopsy\u2010free diagnostic strategy for prostate cancer using mpMRI and PSMA\u2010PET\/CT"],"prefix":"10.1002","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4991-9790","authenticated-orcid":false,"given":"Joshua Yi Min","family":"Tung","sequence":"first","affiliation":[{"name":"Department of Urology Singapore General Hospital  Singapore"},{"name":"Data Science and Artificial Intelligence Laboratory Singapore General Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel Shu\u2010En","family":"Lau","sequence":"additional","affiliation":[{"name":"Department of Urology National University Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edmund Pek Siang","family":"Teo","sequence":"additional","affiliation":[{"name":"Health Services Research Unit Singapore General Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kit Mun","family":"Chow","sequence":"additional","affiliation":[{"name":"Department of Urology Singapore General Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julene Hui Wun","family":"Ong","sequence":"additional","affiliation":[{"name":"Department of Urology Singapore General Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy Siliang","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Urology Singapore General Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiren","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Urology Singapore General Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingqiu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Urology Singapore General Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7567-5924","authenticated-orcid":false,"given":"Xinyan","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Urology Singapore General Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5561-9503","authenticated-orcid":false,"given":"Alvin Yuanming","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Urology Singapore General Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu Guang","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Urology Singapore General Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0365-1899","authenticated-orcid":false,"given":"Kae Jack","family":"Tay","sequence":"additional","affiliation":[{"name":"Department of Urology Singapore General Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue Ping","family":"Thang","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine and Molecular Imaging Singapore General Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9813-9857","authenticated-orcid":false,"given":"Winnie Wing Chuen","family":"Lam","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine and Molecular Imaging Singapore General Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan Mee","family":"Law","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology Singapore General Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry Sun Sien","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Urology Singapore General Hospital  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