Cost Effectiveness of Local Anaesthetic Transperineal Versus Transrectal Biopsy: Results from the TRANSLATE Study
Year: 2025
Type: article
Abstract: BACKGROUND AND OBJECTIVE: A local anaesthetic ultrasound-guided transperineal (LATP) prostate biopsy has advantages over transrectal ultrasound (TRUS)-guided biopsy, with improved magnetic resonance imaging (MRI)-guided prostate cancer detection and lower rates of infection-related complications. However, uncertainty remains regarding the cost effectiveness of an LATP biopsy compared with a TRUS biopsy. METHODS: Between December 2021 and September 2023, the TRANSLATE randomised clinical trial allocated 1126 men to receive either a TRUS (n = 564) or an LATP (n = 562) biopsy at ten sites in the UK. All men were biopsy naïve and underwent prebiopsy MRI. Participants were followed up for 4 mo after a biopsy. The economic analysis is a within-trial analysis at 4 mo after biopsy, conducted from a National Health Service perspective. We assessed resource use, health care costs, and quality-adjusted life years (QALYs) across 4 mo of follow-up from an intention-to-treat perspective. We addressed missing data using multiple imputation. Incremental cost-effectiveness ratios were calculated, with uncertainty characterised using nonparametric bootstrapping. The TRANSLATE trial is registered at ISRCTN (ISRCTN98159689) and is complete. KEY FINDINGS AND LIMITATIONS: The total mean costs over the 4 mo of follow-up were £1062 in the LATP arm and £917 in the TRUS arm (adjusted mean difference £149; 95% confidence interval [CI] £61-236, p = 0.001). The total mean QALYs at 4 mo were 0.282 in the LATP arm and 0.284 in the TRUS arm (adjusted mean difference -0.004; 95% CI -0.009 to 0.001, p = 0.098). CONCLUSIONS AND CLINICAL IMPLICATIONS: An LATP biopsy has a higher mean cost, and no significant difference in mean QALYs, compared with a TRUS biopsy at 4 mo after the procedure. A time of 4 mo is too soon to reflect any impact from the 5.7% diagnostic uplift for LATP versus TRUS biopsy on the detection of intermediate-/high-grade prostate cancer seen in the TRANSLATE trial. A further analysis beyond this period is needed to fully interpret the cost-effectiveness results.
Source: European Urology Focus
Authors: Matthew Little, Jane Wolstenholme, Filipa Landeiro, Ioana R. Marian, Roxanne Williams, J. Francisco Lopez, Claudia Mercader, Mutie Raslan, Christopher Berridge, Jessica Whitburn, Teresa Campbell, Steve Tuck, Vicki S. Barber, Jessica Scaife, Aimi Hewitt, Amy Taylor, Alexander Ooms, Sukanya Ghosh, John M. Reynard, Freddie C. Hamdy, Matthew P.C. Liew, Tom Leslie, James W.F. Catto, Derek J. Rosario, Altan Omer, Daniel W. Good, Rob Gray, Sashi Kommu, Daniel Chung, Hannah Wells, Krishna Narahari, Ruth E. Macpherson, Clare Verrill, Ben Eddy, Hide Yamamoto, Richard J. Bryant, Alastair D. Lamb, Vincent Gnanapragasam, Rakesh Heer, Grace Young, Philip Cornford, William Cross, Jon Oxley, Sian Noble, Sharon Love, Derek Price, Chris Metcalfe
Institutions: University of Oxford, Churchill Hospital, University Hospital Coventry, University Hospitals Coventry and Warwickshire NHS Trust, Wycombe General Hospital, Buckinghamshire Healthcare NHS Trust, Maidstone and Tunbridge Wells NHS Trust, Maidstone Hospital, Wrightington, Wigan and Leigh NHS Foundation Trust, Wrightington Hospital, Milton Keynes Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield, NHS Lothian, Western General Hospital, East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital, Cardiff and Vale University Health Board, University Hospital of Wales, John Radcliffe Hospital, NIHR Oxford Biomedical Research Centre, Tunbridge Wells Hospital, Queen Mary University of London, Barts Cancer Institute
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,800
Funders: National Institute on Handicapped Research, Movember Foundation, Intuitive Surgical, Cancer Research UK, National Institute for Health and Care Research, Department of Health and Social Care, University of Oxford, Prostate Cancer UK, Astellas Pharma, Koç Üniversitesi, John Black Charitable Foundation, Health Technology Assessment Programme
Award: G6850337213
OpenAlex ID: W4417304392