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Microcosting Study of Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography in Prostate Cancer

  • Bonny Parkinson
    Correspondence
    Correspondence: Bonny Parkinson, PhD, Macquarie University Centre for the Health Economy, Level 1, 3 Innovation Rd, Macquarie University, Sydney, NSW 2109, Australia.
    Affiliations
    Macquarie University Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia

    Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia

    Macquarie Business School, Macquarie University, Sydney, NSW, Australia
    Search for articles by this author
  • Rajan Sharma
    Affiliations
    Macquarie University Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia

    Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia

    Macquarie Business School, Macquarie University, Sydney, NSW, Australia
    Search for articles by this author
  • Varinder Jeet
    Affiliations
    Macquarie University Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia

    Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia

    Macquarie Business School, Macquarie University, Sydney, NSW, Australia
    Search for articles by this author
  • Rachel Song
    Affiliations
    Macquarie University Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia

    Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia

    Macquarie Business School, Macquarie University, Sydney, NSW, Australia
    Search for articles by this author
  • Martin Hoyle
    Affiliations
    Macquarie University Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia

    Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia

    Macquarie Business School, Macquarie University, Sydney, NSW, Australia
    Search for articles by this author
Published:August 10, 2022DOI:https://doi.org/10.1016/j.vhri.2022.06.005

      Highlights

      • The cost per prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) procedure is not well established, with previous studies having several limitations, such as costs being based on expert opinion, a single facility, or details not provided. Furthermore, none of the studies estimated the cost of conducting PSMA PET/CT using 18F-DCFPyL.
      • The average cost of PSMA PET/CT based on the microcosting approach was A$1554.77 per PSMA PET/CT procedure, whereas the gross costing approach yielded A$1306.00 per PSMA PET/CT procedure, based on data from 8 facilities in Australia.
      • The cost of PSMA PET/CT is higher than the recently proposed reimbursement rate in Australia, suggesting patients will continue to face substantial out-of-pocket payments and limited access.

      Abstract

      Objectives

      Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) has emerged as a promising imaging tool in prostate cancer diagnosis. PSMA PET/CT radiotracers are produced in-house (gallium-68, eg, 68Ga-PSMA-11) or provided by commercial entities (fluorine-18, eg, 18F-DCFPyL). Nevertheless, the cost per procedure is not well established given that current estimates have several limitations. This study aimed to establish the cost of PSMA PET/CT in Australia.

      Methods

      Hospitals and diagnostic facilities currently conducting PSMA PET/CT in Australia in metropolitan and regional areas completed a survey of PSMA PET/CT throughput, radiotracers involved, and the cost of assets, departmental staffing, consumables, and occupancy. Total costs were estimated using a top-down microcosting approach, involving identifying all relevant cost components and valuing each component for the average patient, and a gross costing approach, involving apportioning cost components at an aggregated level.

      Results

      Data were collected from 8 facilities. The most common radiotracer used was 18F-DCFPyL (7 facilities, 87%), followed by 68Ga-PSMA-11 (4 facilities, 50%). The average cost of PSMA PET/CT was A$1554.77 and A$1306.00 based on the microcosting and gross costing approaches, respectively.

      Conclusions

      This study provides a detailed and accurate estimation of the cost of PSMA PET/CT in Australia. These costs can be used as a benchmark to identify potential efficiencies and help policy makers set the appropriate reimbursement rate for this procedure. The use of data from facilities using different radiotracers in metropolitan and regional areas and with different throughput increases the generalizability of the results, especially in countries with similar health systems.

      Keywords

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