Temporal trends of prostate cancer diagnostics in Australia: Has the introduction of a magnetic resonance imaging prostate subsidy fulfilled its cost-saving promises?

Background: This study aims to assess whether magnetic resonance imaging of the prostate (MRIp) had a statistically significant effect on prostate biopsies in Australia and decreased biopsies performed in Australia. Temporal trends and cost-effectiveness of this policy were also analysed. Methods: National and state-level data were obtained from the Australian Medicare Benefits Schedule from 1 January 2006 to 1 January 2024 on MRIp and prostate biopsies. A regression model was used to calculate the impact of MRIp use on the number of biopsies. Paired t-test was used to determine statistical significance between population-adjusted pre- and post-subsidy rates. Cost-effectiveness of the subsidy was calculated. Results: MRIp had a statistically significant impact on biopsies, with an OR of 1.42 MRIps to biopsies (95% CI: 1.358, 1.473; P < 0.0002) at a national level. State-level data suggested it impacted most, but not all, states. Population-adjusted prostate biopsy rates decreased from 215 per 100,000 men per year to 182 per 100,000 men following the introduction of MRIp subsidy (P = 0.02). Cost analysis suggests that MRIp subsidy has led to approximately $10 million in cost savings since 2018, although projected savings during policy proposal were vastly overestimated. Conclusion: Government subsidised MRIp in Australia has a statistically significant effect on prostate biopsies. There has been a reduction in prostate biopsies, but this is likely more reflective of the rapid development and increasing complexity within prostate cancer diagnostics. Subsidy of MRI is questionable in its cost effectiveness.