Screening for prostate cancer with first-line MRI less cost-effective than first-line PSA testing

Embargoed for release until 5:00 p.m. ET on Monday 3 June 2024    

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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.    
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1. ACP Recommends AI Tech Should Augment Physician Decision-Making, Not Replace It

Abstract: https://www.acpjournals.org/doi/10.7326/M24-0146   

URL goes live when the embargo lifts      

The use of artificial intelligence (AI) in clinical health care has the potential to transform health care delivery but it should not replace physician decision-making, says the American College of Physicians (ACP) in a new policy paper published today. “Artificial Intelligence in the Provision of Health Care,” published in the Annals of Internal Medicine, offers recommendations on the ethical, scientific, and clinical components of AI use, and says that AI tools and systems should enhance human intelligence, not supplant it.

To navigate the risks and ensure best practices, ACP recommends that AI-enabled technology should be limited to a supportive role in clinical decision-making. ACP notes that when being used for clinical decision-making, the technology would more appropriately be called “augmented” intelligence, since the tools should ideally be used to assist clinicians, not replace them. The tools must be developed, tested, and used transparently, while prioritizing privacy, clinical safety, and effectiveness. The use of technology should actively work to reduce, not exacerbate, disparities, ensuring a fair and just health care system. ACP recommends that to ensure accountability and oversight of AI-enabled medical tools, there should be a coordinated federal strategy involving oversight of AI by governmental and non-governmental regulatory entities. The tools should be designed to reduce physician and other clinician burdens in support of patient care, while guided by unwavering principles of medical ethics.

Additionally, to ensure that AI tools are administered safely, ACP advises that training on AI in medicine be provided at all levels of medical education. Physicians must be able to both use the technology and remain able to make appropriate clinical decisions independently, in the case that AI decision support becomes unavailable.  Lastly, efforts to quantify the environmental impacts of AI must continue and mitigation of those impacts should be considered.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with someone from ACP, please contact Jacquelyn Blaser at jblaser@acponline.org.

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2. Screening for prostate cancer with first-line MRI less cost-effective than first-line PSA testing  

Abstract: https://www.acpjournals.org/doi/10.7326/M23-1504  

Editorial:  https://www.acpjournals.org/doi/10.7326/M24-0878  

URL goes live when the embargo lifts     

A cost-effectiveness analysis found that screening for prostate cancer using biparametric magnetic resonance imaging (bpMRI) as a first-line approach is less cost-effective than first-line prostate-specific antigen (PSA) testing with second-line multiparametric MRI (mpMRI). These findings persisted even under the assumption that bpMRI was performed free of charge, showing that these savings were not enough to outweigh the limitations of the first-line MRI approach. The analysis is published in Annals of Internal Medicine. 

 

Researchers from Fred Hutchinson Cancer Center, Beth Israel Deaconess Medical Center, and the Mayo Clinic developed a microsimulation model to evaluate the comparative effectiveness and cost-effectiveness of first-line bpMRI versus first-line PSA with reflex mpMRI for prostate cancer screening. The authors found that first-line MRI-based screening substantially increased rates of false-positive test results, prostate biopsy, and overdiagnosis without proportionately substantial reductions in prostate cancer mortality. They note that even when assuming no cost for first-line bpMRI screening, first-line PSA testing with reflex mpMRI followed by MRI-guided prostate biopsy with or without transrectal ultrasonography–guided biopsy still resulted in lower costs and better quality of life for patients. These findings suggest that screening efforts should focus on strategies that reduce false-positive results and overdiagnoses to improve cost-effectiveness.

The authors of an accompanying editorial from Vanderbilt University Medical Center suggest that high-quality cost-effectiveness analyses are crucial to understanding the effect of changes in clinical practice on the overall health care system. In addition, these types of analyses provide important economic context that could bolster guidance statements if used in their development, as acknowledged by the National Comprehensive Cancer Network. The authors suggest that other organizations should follow suit by incorporating cost-effectiveness data in their guidelines. 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Roman Gulati, MS, please contact rgulati@fredhutch.org.

 

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3. Mental health care still majority of telehealth visits

Abstract: https://www.acpjournals.org/doi/10.7326/M24-0137   

URL goes live when the embargo lifts      

An analysis of the 2021 Medical Expenditure Panel Survey (MEPS) found that while only 9.6% of health care visits took place via telehealth, 43.2% of those visits were to psychiatrists. The analysis is published in Annals of Internal Medicine. 

Researchers from the Agency for Healthcare Research and Quality (AHRQ) conducted an analysis of 232,024 health care visits to describe telehealth use using data from the 2021 MEPS, a nationally representative survey of the civilian noninstitutionalized population and their clinicians. They found that only 9.6% of health care visits took place via telehealth. The data showed that 43.2% to 54.1% of mental health (depending on clinician type), 6.1% of primary care, and 7.8% of specialty physician visits took place via telehealth. During the timeframe studied, the percentage of telehealth visits declined 44% to 49% for non–mental health visits and 18% to 19% for mental health visits, suggesting that use of telehealth after the public health emergency peak has returned closer to pre-emergency levels for non–mental health clinicians. 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Sandra L. Decker, PhD, please contact Sandra.Decker@ahrq.hhs.gov.

 

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