Impact of Australian federal funding on referral patterns of diagnostic multi-parametric MRI of the prostate.

Abstract

Background: Reliable imaging techniques to assist in the diagnosis of prostate cancer (PCa) were not available until the advent of multiparametric magnetic resonance imaging (mpMRI), which has been shown to improve the detection and characterization of prostate lesions. In 2018, the Australian Medicare Benefits Schedule (MBS) extended its coverage to include mpMRI for PCa diagnosis and surveillance.

Methods: This retrospective cohort study evaluated the impact of the MBS item expansion on mpMRI referral patterns, sources, yields and patient demographics at a Victorian center. Referrals for prostate mpMRI were analysed over a 30-month period before and after a 54-month period following the MBS update. All indications were considered, without exclusion criteria. Baseline continuous variables (age, PSA, PSA density, prostate volume, PIRADS score) were summarized using medians and interquartile ranges. Categorical variables were expressed as numbers and proportions. Statistical analyses included Mann-Whitney U-tests and T-tests for continuous variables, preceded by a Shapiro-Wilk normality test. GraphPad Prism 6 (San Diego, California, USA) facilitated data analysis.

Results: Following the MBS update, there was a yearly average increase of 13.8% in mpMRI referrals, notably with a 125% surge in urologist referrals. The proportion of diagnostic scans rose from 42% pre-update to 70% post-update. These results highlight enhanced referral pathways and specific clinical applications of mpMRI after the MBS expansion.

Conclusions: In conclusion, federal funding led to a notable rise in mpMRI utilization. Continued monitoring and analysis of the role of mpMRI in PCa diagnostic algorithms are imperative to optimize its benefits and enhance clinical outcomes.