Introduction:
The widely used method for prostate cancer (PCa) diagnosis, the standard transrectal prostate biopsy (TR-Bx), has up to 5% risk of sepsis. Healthcare-related costs of post-prostate biopsy infections represent a national burden with a calculated post-biopsy cost of up to $19,100 per hospitalization and a calculated added cost to Medicare and insurance companies of $173-$382 for every TR-Bx performed. Avoiding these episodes can mitigate the annual cost of PCa care.
With nearly absent rates of post-biopsy infection, the transperineal prostate biopsy (TP-Bx) approach has emerged as valuable tool and a wide array of TP-Bx modalities such as, grid/template-based or free-hand, utilizing disposable devices, have now been described. Nonetheless, the adoption of this technique has been hampered by the perceived need for general anesthesia, added cost of equipment and supplies. We aim to assess the costs of different TP-Bx approaches performed in-office and ambulatory centers utilizing time-driven activity-based costing (TDABC) methodology.
Methods:
Data were prospectively collected between October 2017 to July 2021 for men undergoing three different approaches of transperineal MRI-targeted biopsy at the outpatient clinic and tertiary hospital of a single center; Free-hand transperineal prostate biopsy under local (fTPLA), grid-based transperineal prostate biopsy under local (gbTPLA) and transperineal prostate biopsy under sedation (TPBS). These data included demographic, procedural, pathologic variables and complications. Clinical significant prostate cancer (CSPC) was defined as GG 2 or greater. Time-driven activity-based costing (TDABC), a form of analysis used to estimate resource demands for a complex clinical process, was performed for these three modalities to capture both direct and indirect costs. Direct costs included human resources, materials, equipment and inderect costs factored depreciation and overhead. TDABC was defined as the sum of its resources. All calculations were performed in SPSS v.28. Statistical significance was defined at alpha <0.05.
Results:
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A total of 152 men were included. Age, BMI, PSA and prostate volume were similar among the three different prostate biopsy modalities; fTPLA (n=26) vs gbTPLA (n=45) vs. TPBS (n=81), all p>0.05. Detection of CSPC on combined systematic and targeted biopsy was similar for fTPLA, gbTPLA vs. TPBS (42% vs 24% vs. 36%; p>0.05). For fTPLA vs gbTPLA vs TPBS, the complication rate was 0%, 2.6% and 6.1%, with only 1 infectious complication reported in the sedation cohort. The median procedure time and total time in hospital/clinic for fTPLA vs. gbTPLA vs TPBS were 9/81 vs 22.5/63.5 vs. 17.5/185.5 minutes. TDABC analysis demonstrated comparative total costs of $1141.64 for fTPLA, $961.64 for the gbTPLA, and $2208.16 for TPBS, respectively, with the added overhead costs of the operating and recovery rooms driving the difference between these methods. Relative costs of disposables for all TP-bx fluctuated between 3-22% (absolute price range $80.53-$260.53).
Conclusion:
TP-Bx with local anesthesia is safe and less expensive when compared to those performed under sedation. Compared with gbTPLA approach, the actual procedure length was shorter for the fTPLA, however there was no statistical difference between total in hospital time for the patient and total costs of these two modalities. The short-term increase in health-care spending on added costs of disposables for the fTPLA and gbTPLA may be offset by the absence of post-procedural infections when compared to TR-Bx.
Funding: N/A
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