Study finds microRNA-based assay may reduce costs, improve QALYs in prostate cancer

Data recently published in the Journal of Health Economics and Outcomes Research suggest that toxicity risk assessment with the PROSTOX ultra test can deliver cost savings for the health care system and gains in quality-adjusted life-years (QALYs) for men with prostate cancer considering radiation therapy.¹

The PROSTOX ultra test is a clinically validated microRNA-based assay that can identify men with localized prostate cancer who are at a higher risk of developing late genitourinary (GU) toxicity from stereotactic body radiation therapy (SBRT). Results from the germline genetic test can help guide treatment decision-making based on an individual patients’ risk.

“Physicians in practice using PROSTOX ultra are seeing its benefits in helping their patients avoid late GU toxicity from SBRT. These new results also now show that PROSTOX ultra meaningfully reduces the long-term cost burden on the health care system,” said Melissa Stoppler, MD, Executive Vice President of Medical Affairs at MiraDx, in a news release on the findings.² “This new evidence further validates the value of integrating the test into treatment considerations for localized prostate cancer.”

For the study, investigators modeled clinical pathways incorporating the PROSTOX ultra test vs treatment guided by the current standard of care (SOC).

According to the authors, “High or low risk assessment influences whether patients receive stereotactic body radiation therapy, conventionally fractionated radiotherapy [CFRT], or prostatectomy, impacting toxicity-related treatment costs and quality-of-life decrements.”

Using a decision tree model, the analysis resulted in 73.3% of the total PROSTOX ultra population receiving SBRT, 9.5% receiving CFRT, and 17.3% undergoing prostatectomy. In the SOC arm, 38.3% received SBRT, 12.4% received CFRT, and 49.4% underwent prostatectomy.

At 5 years, the estimated total cost for patients using PROSTOX ultra risk assessment was $47,683 vs $67,298 with SOC risk assessment. This translates to a cumulative total cost savings over 5 years of $19,615 per patient.

The authors also noted, “When running the model at various costs for PROSTOX ultra, positive savings were still seen even if priced over $10,000.”

Findings showed that the greatest impact on 5-year cost savings with the percentage of patients in the SOC arm receiving prostatectomy. The authors also noted similarly influential parameters, which included the “the percentage of SOC surgical patients who would instead use SBRT with a low-risk PROSTOX ultra result and the adherence to the PROSTOX ultra result for SOC radiation patients.”

Incorporation of PROSTOX ultra also demonstrated long-term cost savings, with lifetime costs of $82,337 with the germline genetic test vs $107,114 with SOC. Over a lifetime, the PROSTOX ultra pathway was expected to save $24,777 per tested patient, while adding 0.24 QALYs compared with the standard risk assessment pathway.

“This analysis emphasized the economic benefits of adapting PROSTOX ultra as a prediction tool for risk of late GU toxicity with SBRT in patients with prostate cancer,” the authors concluded.¹ “The implementation of PROSTOX ultra was estimated to save $19,615 per tested patient over a 5-year period. The analysis also supported the cost-effectiveness of PROSTOX ultra compared with SOC, predicting an increase in QALYs and reductions in costs over a lifetime.”

REFERENCES

1. Cooper JT, Schneider JE. Economic evaluation of a novel microRNA-based assay to determine risk of late genitourinary radiation toxicity in patients with prostate cancer. JHEOR. 2025;12(2):246-252. doi:10.36469/​001c.146844

2. New publication shows PROSTOX™ ultra test delivers significant health system cost savings and quality-of-life gains for prostate cancer patients undergoing radiation therapy. News release. MiraDx. December 18, 2025. Accessed December 18, 2025. https://www.businesswire.com/news/home/20251218349728/en/New-Publication-Shows-PROSTOX-ultra-Test-Delivers-Significant-Health-System-Cost-Savings-and-Quality-of-Life-Gains-for-Prostate-Cancer-Patients-Undergoing-Radiation-Therapy