MRI is cost-effective replacement for CT scans to monitor early stage testicular cancer
20 Feb 2023
Replacing CT (computed tomography) with MRI (magnetic resonance imaging) scans would be a cost-effective way to monitor men after treatment for early stage testicular cancer, according to new findings from the TRISST clinical trial. This would reduce exposure to harmful radiation while still enabling doctors to spot cancer relapses in good time.
The cost effectiveness analysis was presented at the American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium on 18th February 2023.
Under the current standard of care, men with stage one testicular cancer have surgery to remove the affected testicle. They are then monitored for five years using regular CT scans to check if the cancer returns.
While CT scans are effective at spotting early signs of cancer, they expose people to potentially harmful radiation. This may slightly increase the risk of developing other cancers in future.
MRI is another way to see inside the body and does not involve any radiation exposure. Earlier results from the TRISST study showed that MRI is just as good as CT at detecting cancer relapse and that men could safely have fewer scans. However, MRI scans are typically more expensive, so it was important to understand whether this would also be cost effective.
In the study, 669 men were randomised across four groups who received either the standard seven CT scans, a reduced schedule of three CT scans, or the same two regimens using MRI scans instead. Researchers assessed the participants’ health at the start of the study and over the next six years. They also collected data on their use of healthcare resources, including scans, hospitalisations, and treatment for cancer relapse.
The team estimated the total costs and total quality-adjusted life years (QALY) for each treatment schedule. QALY gives a measure of not just length but also quality of life. It is calculated by estimating the years of life remaining after treatment, then weighting each year with a quality of life score.
Throughout the study, only 82 men (12%) had a cancer relapse, so the biggest costs came while men were disease-free. There were slightly better health benefits compared with other groups for men who had seven MRI scans, however this was more expensive. Three MRI scans had similar costs and benefits to the standard seven CT scans, whereas three CT scans worked out more expensive than both when QALY was accounted for.
Overall, considering the costs and capacity restraints of MRI scans and the reduced radiation exposure compared with CT scans, a three scan MRI schedule may be the best option to replace the current standard CT scan monitoring.
TRISST was funded by the Medical Research Council (part of UK Research and Innovation) and Cancer Research UK. The trial took place in hospitals throughout the UK.