A quantitative analysis of the costs and benefits of prostate cancer screening

Abstract

The present study attempts to quantitate in an economically and clinically meaningful manner the cost and cost-effectiveness of prostate cancer screening and subsequent treatment, including complications from that treatment. Outcome data from large prostate cancer screening trials using prostate specific antigen (PSA) and digital rectal examination (DRE) and PSA alone were used to construct the screening model. The benefit of screening is expressed in years of life saved by screening, which is calculated by comparing the survival rate of men with prostate cancer to the survival rate of men in the general population. The cost of screening, treatment, and complications were estimated using the Medicare data base and published reports on the cost, morbidity and mortality for radical prostatectomy. The cost per year of life saved by prostate cancer screening with PSA and DRE was $2339 -3005 for men aged 50 -59, $3905 -5070 for men aged 60 -69, and $3574 -4627 overall for men aged 50 -69. The cost per year of life saved by prostate cancer screening with PSA alone for men aged 50 -70 was $3822 -4956. A sensitivity analysis demonstrates that the cost per year of life saved by prostate cancer screening will not change substantially even if the assumptions in this model have been underestimated or overestimated by 100%. This study quantifies only those parameters which can be reliably compared in concrete terms such as dollars, treatment impact on survival, published complication rates and published treatment costs. Using this type of analysis, prostate cancer screening appears to be a cost-effective intervention. However, the issue of whether prostate cancer screening is cost-effective will be decided definitively only when randomized, controlled trials are available to quantify the costs and benefits of prostate cancer screening. Prostate Cancer and Prostatic Diseases (2001) 4, 138-145.

Cost-effectiveness of Prostate Cancer Screening: A Simulation Study Based on ERSPC Data

“…Most studies have shown that screening is less cost-effective at higher ages (5). Our study suggests a lower age at cessation of screening of 59 to 61 years, whereas previous studies suggest stopping screening at age 70 to 71 years (23,26,28,31). Our results can change with longer follow-up of the ERSPC trial, as a study in Göteborg suggested that nine years after termination of screening the prostate cancer mortality in the screen arm caught up (33).…”

“…Previous studies concerning the costs or cost-effectiveness of prostate cancer screening did not evaluate life-years gained or QALYs gained (19)(20)(21)(22)(23)(24) or were based on assumptions of mortality reduction because of screening and did not use results of a prostate cancer screening trial to calibrate the model (25)(26)(27)(28)(29)(30)(31).…”

A Markov model to analyze cost-effectiveness of screening for severe combined immunodeficiency (SCID)

“…Our modeling indicates that the cost-effectiveness of TREC screening for SCID compares favorably with screening programs for other rare conditions as well as common diseases such as prostate cancer [34]. The benefits may be enhanced because the TREC assay detects non-SCID T cell lymphocytopenias in addition to SCID, such as DiGeorge syndrome, which are detected by low TRECs, as described in the first year of statewide TREC screening in Wisconsin [31].…”

Urothelial bladder cancer: biomarkers for detection and screening

“…While it is important to identify a good population for screening and tests with high performance characteristics, unless they are cost‐effective it is unlikely that any UBBTM will be deemed acceptable for widespread use. Screening for prostate, breast, colon and cervical cancer are currently accepted, but can result in costs up to USA $50 000 per life year saved [82–84]. There is a wide variability in costs of UBBTM, with a relatively low cost for point‐of‐care tests of USA $20–24 for BladderChek and the BTAstat test, compared with more labour‐intensive tests such as UroVysion and ImmunoCyt, which cost >$300.…”