Cost-Effectiveness of PSMA-PET/CT When Compared With Conventional Imaging

Neeraj Agarwal, MD: This is a wonderful information. Thank you for sharing and… So great to learn from your wisdom and knowledge about this area.

Dr. Agarwal: So it looks like, just want to summarize for our colleagues out there who are listening, PSMA-based scans are going to be universally available. Multiple tracers are going to be approved or are already approved. They’re endorsed by guidelines, and they’re covered by Medicare and, in turn, insurance carriers. So it looks like it is a matter of time. We are talking about months, if not years, or rather, we are talking maybe a year before these scans are widely available. How do you think the cost is going to be impacting the use of PSMA-PET scan, PSMA-based scan in our practices? This is the last question for you, Jeremie.

Dr. Jeremie Calais, MD MSC: Okay.

Dr. Agarwal: Do you see any cost issues with this?

Dr. Calais: This will take some time, I think, to be able to really answer to that questions. First of all, you need to have the final commercial costs, which we don’t know yet, because many of these compounds owned by industry. Their rates are not finally set up. Some cost will differ from different insurances’ reimbursement, and also from one hospital to another. So that’s one first thing.

Dr. Calais: Then it’s not always easy to assess what is really cost effectiveness if you talk in terms of just the procedure cost only, or all the implications down the road that performing this scan implies to the patient care in terms of treatments indications, in terms of monitoring, in terms of treatments, patient staging, you put patient in different categories, you order different treatment at the end, and it’s not straightforward to assess how this turn out into better cost effectiveness.

Dr. Calais: The proPSMA study, just as mentioned by Dr. [Towards 00:02:16] before, they run a subsequent analysis post-touch on the cost effectiveness in that exact setting. We also run another study here at UCLA looking at the salvage radiation setting, putting many data coming from all the big trials, making assumptions what would have happened without the scan or with the scan and trying to see all the treatments down the road that the patient would have with their different life expectancy and progression time free survival and this was led by our radiation oncologist here at UCLA. At the end, PSA PET scan was able to save more than 15 to 20K per patients overall.

Dr. Calais: Of course, there is a lot of things you can discuss about the methodology about that, but-

Dr. Agarwal: Yes, absolutely. Yeah.

Dr. Calais: … it goes in the way that usually if you have a more accurate testa, you are supposed to treat better the patients so they live longer in a healthy manner and you can also better direct adapted treatment with less failure. It is supposed to be more cost effective.

Dr. Agarwal: So based on the prelim studies, smaller studies, it seems to be cost effective, looks like, which is great. But time will tell how insurance companies are going to be estimating the cost and how easy it will be to get reimbursement for the PSMA-based scans.

Dr. Agarwal: Having said that, I think this is all exciting news for our patients, that they will have a much better imaging modality when they are being diagnosed with prostate cancer, or they are being failed by earlier therapies and being considered for salvage radiation therapy, or when they are being considered for treatment for their metastatic prostate cancer. I think PSMA imaging looks like is going to be playing a role across the spectrum of prostate cancer treatment and management and starting with a diagnosis.