{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T23:49:09Z","timestamp":1778543349675,"version":"3.51.4"},"reference-count":38,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,1,11]],"date-time":"2025-01-11T00:00:00Z","timestamp":1736553600000},"content-version":"unspecified","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,11,18]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Magnetic resonance-guided transurethral ultrasound ablation (MR-TULSA) is a new focal therapy for treating localised prostate cancer that is associated with fewer adverse effects (AEs) compared with established treatments. To support large-scale clinical implementation, information about cost-effectiveness is required.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the cost\u2013utility of MR-TULSA compared with robot-assisted radical prostatectomy (RARP), external beam radiation therapy (EBRT) and active surveillance (AS) for patients with low- to favourable intermediate-risk localised prostate cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting and participants<\/jats:title>\n                    <jats:p>A Markov model was developed targeting 60-year-old men diagnosed with low- to intermediate-risk localised prostate cancer over a time horizon of 40 years from the German Statutory Health Insurance (SHI) perspective. To assess the robustness of the results, deterministic and probabilistic sensitivity analyses were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>Four different treatment strategies were compared: minimally invasive MR-TULSA, two definitive approaches (RARP and EBRT) and one observational strategy (AS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measurements and statistical analysis<\/jats:title>\n                    <jats:p>Outcomes were measured in overall costs, quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>AS generated the highest number of QALYs (12.67), followed by MR-TULSA (12.35), EBRT (12.35) and RARP (12.20). RARP generated the lowest costs (\u20ac 46 997) over one patient\u2019s lifetime, while MR-TULSA was a slightly more expensive alternative (\u20ac48 826). The incremental cost-effectiveness ratio (ICER) of AS compared with RARP was \u20ac11 600 per QALY and of MR-TULSA compared with RARP was \u20ac12 193 per QALY, while EBRT was dominated. At a willingness-to-pay of \u20ac20 000 per QALY, the probability of being cost-effective is 44% for AS, 25% for RARP, 25% for MR-TULSA and 6% for EBRT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>All treatment options for 60-year-old men diagnosed with low- to intermediate-risk localised prostate cancer are affected by considerable uncertainty. Accepting high follow-up costs by applying a higher willingness-to-pay, AS is the most favourable treatment option.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-088495","type":"journal-article","created":{"date-parts":[[2025,1,12]],"date-time":"2025-01-12T00:05:20Z","timestamp":1736640320000},"page":"e088495","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Cost\u2013utility analysis of MR imaging-guided transurethral ultrasound ablation for the treatment of low- to intermediate-risk localised prostate cancer"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct05027477","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Paul","family":"Muhler","sequence":"first","affiliation":[{"name":"Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dennis","family":"Akuamoa-Boateng","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, OWL Medical Campus Hospital Site Herford, Herford, Germany"},{"name":"Department of Radiation Oncology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Rosenbrock","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Stock","sequence":"additional","affiliation":[{"name":"Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5576-0192","authenticated-orcid":false,"given":"Dirk","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Axel","family":"Heidenreich","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4832-7294","authenticated-orcid":false,"given":"Julia","family":"Sim\u00f5es Corr\u00eaa Galendi","sequence":"additional","affiliation":[{"name":"Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany"},{"name":"Department of Internal Medicine, Sao Paulo State University (UNESP), Medical School, Campus Botucatu, Botucatu, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,1,11]]},"reference":[{"key":"2025120519233470000_15.1.e088495.1","unstructured":"Statistisches Bundesamt (Destatis) . H\u00e4ufigste m\u00e4nnliche todesursachen 2021: gesundheit, 2023. Available: https:\/\/www.destatis.de\/DE\/Themen\/Gesellschaft-Umwelt\/Gesundheit\/Todesursachen\/_inhalt.html [Accessed 05 Jul 2023]."},{"key":"2025120519233470000_15.1.e088495.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.2009.08716.x"},{"key":"2025120519233470000_15.1.e088495.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2007.08.055"},{"key":"2025120519233470000_15.1.e088495.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2214122"},{"key":"2025120519233470000_15.1.e088495.5","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1007\/s00345-022-04024-0","article-title":"Alternative- and focal therapy trends for prostate cancer: a total population analysis of in-patient treatments in Germany from 2006 to 2019","volume":"40","author":"Flegar","year":"2022","journal-title":"World J Urol"},{"key":"2025120519233470000_15.1.e088495.6","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1097\/JU.0000000000001362","article-title":"Magnetic Resonance Imaging-Guided Transurethral Ultrasound Ablation of Prostate Cancer","volume":"205","author":"Klotz","year":"2021","journal-title":"J Urol"},{"key":"2025120519233470000_15.1.e088495.7","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1080\/13696998.2023.2251849","article-title":"Focal therapy versus radical prostatectomy and external beam radiotherapy as primary treatment options for non-metastatic prostate cancer: results of a cost-effectiveness analysis","volume":"26","author":"Reddy","year":"2023","journal-title":"J Med Econ"},{"key":"2025120519233470000_15.1.e088495.8","first-page":"3","article-title":"Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) Statement: Updated Reporting Guidance for Health Economic Evaluations","volume":"25","author":"Husereau","year":"2022","journal-title":"V H"},{"key":"2025120519233470000_15.1.e088495.9","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1001\/jamaoncol.2023.0254","article-title":"Prostate-Specific Antigen Screening Should Not Be Covered by Publicly Funded Health Insurance","volume":"9","author":"Takahashi","year":"2023","journal-title":"JAMA Oncol"},{"key":"2025120519233470000_15.1.e088495.10","unstructured":"Leitlinienprogramm Onkologie . S3-leitlinie prostatakarzinom: version 7.0. 2024."},{"key":"2025120519233470000_15.1.e088495.11","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1007\/s00345-016-1813-7","article-title":"National trends and differences in morbidity among surgical approaches for radical prostatectomy in Germany","volume":"34","author":"Stolzenburg","year":"2016","journal-title":"World J Urol"},{"key":"2025120519233470000_15.1.e088495.12","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1007\/s00432-020-03327-2","article-title":"Results of a randomized trial of treatment modalities in patients with low or early-intermediate risk prostate cancer (PREFERE trial)","volume":"147","author":"Wiegel","year":"2021","journal-title":"J Cancer Res Clin Oncol"},{"key":"2025120519233470000_15.1.e088495.13","doi-asserted-by":"crossref","DOI":"10.1186\/1472-6963-14-163","article-title":"The cost-utility of open prostatectomy compared with active surveillance in early localised prostate cancer","volume":"14","author":"Koerber","year":"2014","journal-title":"BMC Health Serv Res"},{"key":"2025120519233470000_15.1.e088495.14","doi-asserted-by":"crossref","DOI":"10.1186\/s12885-020-07276-4","article-title":"Modelling the lifetime cost-effectiveness of radical prostatectomy, radiotherapy and active monitoring for men with clinically localised prostate cancer from median 10-year outcomes in the ProtecT randomised trial","volume":"20","author":"Sanghera","year":"2020","journal-title":"BMC Cancer"},{"key":"2025120519233470000_15.1.e088495.15","doi-asserted-by":"publisher","DOI":"10.1016\/S0090-4295(02)02268-9"},{"key":"2025120519233470000_15.1.e088495.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2006.04.029"},{"key":"2025120519233470000_15.1.e088495.17","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1111\/bju.15268","article-title":"Magnetic resonance imaging-guided transurethral ultrasound ablation in patients with localised prostate cancer: 3-year outcomes of a prospective Phase I study","volume":"127","author":"Nair","year":"2021","journal-title":"BJU Int"},{"key":"2025120519233470000_15.1.e088495.18","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/j.eururo.2018.06.006","article-title":"A Multicentre Study of 5-year Outcomes Following Focal Therapy in Treating Clinically Significant Nonmetastatic Prostate Cancer","volume":"74","author":"Guillaumier","year":"2018","journal-title":"Eur Urol"},{"key":"2025120519233470000_15.1.e088495.19","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.eururo.2019.10.030","article-title":"Ten-year Mortality, Disease Progression, and Treatment-related Side Effects in Men with Localised Prostate Cancer from the ProtecT Randomised Controlled Trial According to Treatment Received","volume":"77","author":"Neal","year":"2020","journal-title":"Eur Urol"},{"key":"2025120519233470000_15.1.e088495.20","unstructured":"Statistisches Bundesamt (Destatis) . Sterbeziffern: sterbef\u00e4lle je 1.000 einwohner in den sterbeziffern: sterbef\u00e4lle je 1.000 einwohner in den jeweiligen altersgruppen nach geschlecht in deutschland im jahr 2020. 2021. Available: https:\/\/de.statista.com\/statistik\/daten\/studie\/3057\/umfrage\/sterbeziffern-nach-alter-und-geschlecht\/ [Accessed 24 Feb 2024]."},{"key":"2025120519233470000_15.1.e088495.21","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1903835"},{"key":"2025120519233470000_15.1.e088495.22","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1016\/j.eururo.2019.07.012","article-title":"Robust Health Utility Assessment Among Long-term Survivors of Prostate Cancer: Results from the Cancer of the Prostate Strategic Urologic Research Endeavor Registry","volume":"76","author":"Jeong","year":"2019","journal-title":"Eur Urol"},{"key":"2025120519233470000_15.1.e088495.23","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000156862.33341.45"},{"key":"2025120519233470000_15.1.e088495.24","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1209978"},{"key":"2025120519233470000_15.1.e088495.25","unstructured":"DRG Research Group . Webgrouper. Available: https:\/\/www.drg-research-group.de\/index.php?option=com_webgrouper&view=webgrouper&Itemid=112 [Accessed 11 Oct 2024]."},{"key":"2025120519233470000_15.1.e088495.26","unstructured":"Allgemeine methoden: version 6.1 Vom 24.01.2022. 6 ed. K\u00f6ln, 2022. Available: https:\/\/d-nb.info\/1251569048\/34"},{"key":"2025120519233470000_15.1.e088495.27","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-015-0327-2"},{"key":"2025120519233470000_15.1.e088495.28","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1111\/bju.14867","article-title":"Cost-utility analysis of focal high-intensity focussed ultrasound vs active surveillance for low- to intermediate-risk prostate cancer using a Markov multi-state model","volume":"124","author":"B\u00e9nard","year":"2019","journal-title":"BJU Int"},{"key":"2025120519233470000_15.1.e088495.29","unstructured":"Halbe L , Persigehl T , Kreylos L , et al . 5 jahre tulsa-pro an der uniklinik k\u00f6ln: ergebnisse der ersten 46 patienten. Der weg zu einem individuellen therapiekonzept. In: 69. Kongress der Nordrhein-Westf\u00e4lischen Gesellschaft f\u00fcr Urologie 2024. German Medical Science GMS Publishing House, 2024."},{"key":"2025120519233470000_15.1.e088495.30","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.vhri.2018.08.002","article-title":"Comparing Use of Health Technology Assessment in Pharmaceutical Policy among Earlier and More Recent Adopters in the European Union","volume":"16","author":"Beletsi","year":"2018","journal-title":"Val Health Reg Issues"},{"key":"2025120519233470000_15.1.e088495.31","doi-asserted-by":"publisher","DOI":"10.1038\/s41391-022-00501-0"},{"key":"2025120519233470000_15.1.e088495.32","unstructured":"Kilmer S . Profound medical announces first patients treated in prospective, randomized clinical trial comparing the tulsa procedure to radical prostatectomy. GlobeNewswire; 2022."},{"key":"2025120519233470000_15.1.e088495.33","first-page":"E7","article-title":"Active surveillance in favorable intermediate-risk prostate cancer patients: Predictors of deferred intervention and treatment choice","volume":"16","author":"Sayyid","year":"2022","journal-title":"Can Urol Assoc J"},{"key":"2025120519233470000_15.1.e088495.34","doi-asserted-by":"crossref","DOI":"10.3390\/jpm14010084","article-title":"Health Policy for Prostate Cancer Early Detection in the European Union and the Impact of Opportunistic Screening: PRAISE-U Consortium","volume":"14","author":"Beyer","year":"2024","journal-title":"J Pers Med"},{"key":"2025120519233470000_15.1.e088495.35","doi-asserted-by":"crossref","unstructured":"Leenen RCA , Venderbos LDF , Helleman J , et al . Prostate Cancer Early Detection in the European Union and UK. Eur Urol 2024. doi:10.1016\/j.eururo.2024.07.019","DOI":"10.1016\/j.eururo.2024.07.019"},{"key":"2025120519233470000_15.1.e088495.36","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(16)00111-X"},{"key":"2025120519233470000_15.1.e088495.37","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1111\/j.1464-410X.2009.09136.x","article-title":"Treatment failure and clinical progression after salvage therapy in men with biochemical recurrence after radical prostatectomy: radiotherapy vs androgen deprivation","volume":"106","author":"Song","year":"2010","journal-title":"BJU Int"},{"key":"2025120519233470000_15.1.e088495.38","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2011.03.011"}],"updated-by":[{"DOI":"10.1136\/bmjopen-2024-088495corr1","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T00:00:00Z","timestamp":1740528000000}}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-088495","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T03:23:46Z","timestamp":1764991426000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-088495"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,11]]},"published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1136\/bmjopen-2024-088495"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-088495","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]}}}