Complex Implementation Factors Demonstrated When Evaluating Cost-Effectiveness and Monitoring Racial Disparities Associated with [18F]DCFPyL PET/CT in Prostate Cancer Men

Prostate cancer is the most prevalent cancer among men in the United States. The Centers for Medicare and Medicaid Services covers prostate specific antigen testing and digital rectal examination annually for men with Medicare above the age of 50 years. Thus, those above the age of 50 have greater access to screening than those under the age of 50, resulting in higher rates of cancer diagnosis with increasing age and associated with higher stage. This particularly affects African American patients with Medicare who were more likely to present with aggressive disease at diagnosis, demonstrating the importance of addressing health disparities in prostate cancer management, a prioritized initiative at Weill Cornell Medicine.

Prostate specific membrane antigen (PSMA) PET/CT is an established imaging modality at initial staging and biochemical recurrence. However, cost and limited access have created challenges to its incorporation in the United States Healthcare system and lead to suboptimal utilization of this new modality. In our single institutional demographic study, European Ancestry patients had disproportionate access to PSMA PET/CT despite the commercial availability of the agent. African American patients were once again more likely to be scanned as a clinical trial patient than as a standard of care patient. ¹⁸F-DCFPyL PET/CT was offered predominantly by institutions located in wealthy neighborhoods with a predominance of men with European ancestry. If geographic access was omitted, we found that the upfront costs of ¹⁸F-DCFPyL PET/CT was greater than alternative prostate cancer-related imaging options. However, we were able to demonstrate that total lifetime costs were reduced when PSMA PET/CT was used due to the radiopharmaceutical’s ability to detect aggressive disease at earlier stages.

To address the stark disparities demonstrated in our study, more centers nationwide need to offer PSMA PET/CT Imaging. Commercially, new PSMA agents and cost competition may also help address disparity-related concerns in the United States Healthcare system, especially when considering the increasing importance of PSMA PET evaluation prior to PSMA-targeted radionuclide therapy.

Written by: Kritika Subramanian, MD,¹ Joseph R Osborne, MD, PhD,¹ & Jones T Nauseef, MD, PhD

Division of Molecular Imaging and Therapeutics, Department of Radiology, Weill Cornell Medicine, New York, NY, USA.
Department of Medical Oncology, Weill Cornell Medicine, New York, NY, USA.

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