Transperineal prostate biopsy under local vs general anaesthesia: a cost-effectiveness analysis

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dc.contributor.authorRoberts, Matthew J.en
dc.contributor.authorArora, Shikshaen
dc.contributor.authorYao, Henry H.en
dc.contributor.authorHogan, Donnachaen
dc.contributor.authorDias, Brendanen
dc.contributor.authorO'Connell, Helen E.en
dc.contributor.authorWetherell, Daviden
dc.contributor.authorZargar, Homayounen
dc.contributor.authorKwok, Michaelen
dc.contributor.authorMcGeorge, Stephen P.en
dc.contributor.authorPearce, Adamen
dc.contributor.authorYaxley, Johnen
dc.contributor.authorTuffaha, Haithamen
dc.contributor.funderMetro North Office of Research, Queensland Healthen
dc.contributor.funderThe University of Queenslanden
dc.contributor.funderSylvia and Charles Viertel Charitable Foundationen
dc.contributor.funderRoyal Brisbane and Women's Hospitalen
dc.contributor.funderRoyal Brisbane and Women's Hospital Foundationen
dc.date.accessioned2025-04-24T15:49:52Z
dc.date.available2025-04-24T15:49:52Z
dc.date.issued2025en
dc.description.abstractObjectives: To estimate the cost effectiveness of local anaesthetic (LA) transperineal prostate biopsy (TPB) compared to general anaesthetic (GA) TPB, considering both hospital/health system and societal perspectives. Patients and Methods: Individual-patient data from a prospective pilot study of 80 patients who underwent LA (n = 40) or GA (n = 40) TPB according to patient preference was used. A cost-effectiveness analysis was conducted using a decision tree model considering cancer detection rates, perioperative and return to work considerations between LA and GA TPB. The economic model included costs associated with consumables, device (capital, maintenance) and personnel for each approach. Cost-effectiveness was evaluated in terms of the incremental cost/quality-adjusted life-years (QALYs) and incremental net monetary benefit. Probabilistic and one-way sensitivity analyses were performed. Results: Clinical parameters were generally similar between groups, including overall (55%) and significant (35% vs 23%; P = 0.32) cancer detection and procedure-specific duration (20 vs 21 min; P = 0.53). Total procedure and recovery durations were longer in the GA group by 8 min (P < 0.001) and 32.5 min (P < 0.001), respectively. Participants in the LA group returned to work earlier than the GA group (2 vs 4 days; P = 0.046). There was a marginal gain in QALYs between the LA and GA groups (0.82385 vs 0.82383), but LA TPB had lower costs (Australian dollars [AU$]715.80 vs AU$1673.58), with an estimated average cost savings of ~AU$959. From the societal perspective, driven by the reduction in productivity loss, the average cost savings with LA TPB were ~AU$1639. Sensitivity analyses showed the probability of LA being cost effective was 100%, while utilisation of operating theatre for GA TPB was the main driver of cost difference. Conclusion: Performing TPB via the LA approach would be cost-saving from both hospital and societal perspectives without reducing the accuracy of the biopsy. en
dc.description.sponsorshipMetro North Office of Research, Queensland Health (Clinician Research Fellowship); The University of Queensland (Research support package); Sylvia and Charles Viertel Charitable Foundation (Viertel Clinical Investigator Award); Royal Brisbane and Women's Hospital (RBWH) and RBWH Foundation (Project Grant)en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationRoberts, M. J., Arora, S., Yao, H. H., Hogan, D., Dias, B., O'Connell, H. E., Wetherell, D., Zargar, H., Kwok, M., McGeorge, S. P. and Pearce, A. (2025) 'Transperineal prostate biopsy under local vs general anaesthesia: a cost‐effectiveness analysis', BJU International. DOI: 10.1111/bju.16722en
dc.identifier.doi10.1111/bju.16722en
dc.identifier.issn14644096en
dc.identifier.journaltitleBJU Internationalen
dc.identifier.urihttps://hdl.handle.net/10468/17322
dc.language.isoenen
dc.publisherJohn Wiley and Sons Incen
dc.rights© 2025, the Author(s). BJU International published by John Wiley & Sons Ltd on behalf of BJU International. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use,distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.en
dc.rights.urihttps://creativecommons.org/licenses/by-nc/4.0/
dc.subjectCancer detectionen
dc.subjectComplicationsen
dc.subjectCost-effectiveness analysisen
dc.subjectEconomic evaluationen
dc.subjectLocal anaesthesiaen
dc.subjectProstate canceren
dc.subjectTransperineal biopsyen
dc.titleTransperineal prostate biopsy under local vs general anaesthesia: a cost-effectiveness analysisen
dc.typeArticle (peer reviewed)en
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