Cost-effectiveness of prostate cancer screening with multiparametric magnetic resonance imaging in the Brazilian Unified Health System
Isabela Sosnitzki Eleutério Rosa, Luiz Vinicius de Alcantara Sousa, Daniel de Iracema Gomes Cubero, Auro Del Giglio
Abstract
Objective: To evaluate the cost-effectiveness of two diagnostic strategies for prostate cancer screening in men with prostate-specific antigen (PSA) ≥ 3 ng/mL from the perspective of the Brazilian Unified Health System (SUS). Methd/ps A decision-tree analytical model was developed using efficacy data from the Göteborg-2 randomized controlled trial. The compared strategies were: Strategy 1 (PSA + multiparametric MRI [mpMRI] with selective biopsy for PI-RADS 3–5 findings) and Strategy 2 (PSA + universal systematic biopsy). Direct costs were estimated from the SIGTAP/DATASUS table (2024). Effectiveness was defined as detection of clinically significant prostate cancer (ISUP grade ≥ 2). Two scenarios were analyzed: (A) mpMRI costs included in both strategies; (B) mpMRI costs excluded from Strategy 2. Mean cost, effectiveness, incremental differences, and incremental cost-effectiveness ratio (ICER) were calculated. Resultps In Scenario A, Strategy 2 showed higher effectiveness (0.1732 vs. 0.1554), with an incremental cost of R$153.99 and an ICER of R$8,631.43 per additional case detected. In Scenario B, Strategy 2 was economically dominant (ICER = −R$6,530.95). The mpMRI-guided strategy reduced biopsies by 58% and overdiagnosis of ISUP 1 tumors by 50%. Sensitivity analysis confirmed the robustness of results. Conclusion: mpMRI improves the diagnostic efficiency of prostate cancer screening; however, its cost-effectiveness within the SUS critically depends on the technology financing model, requiring structured planning for equitable incorporation.
Keywords
Referências
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Submetido em:
25/03/2026
Revisado em:
27/04/2026
Aceito em:
06/05/2026
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