Cost-effectiveness of prostate cancer screening: a systematic review of decision-analytical models

Sanghera, Sabina; Coast, Joanna; Martin, Richard M.; Donovan, Jenny; Mohiuddin, Syed

doi:10.1186/s12885-017-3974-1

Cited by 35 publications

(32 citation statements)

References 19 publications

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“…The European Randomised Study of Screening for Prostate Cancer (ERSPC; ISRCTN49127736) found that four-yearly screening for prostate cancer, using the prostate-specific antigen (PSA) test, for ages 55-69 years increased incidence by 41% and reduced mortality by 20% over 16 years [3]. The PSA test is inexpensive but has diagnostic limitations that lead to unnecessary biopsies, over-diagnosis, over-treatment and increased costs [3][4][5][6]. We use the term "screening" in a manner that includes both organised screening and opportunistic testing.…”

Section: Introductionmentioning

confidence: 99%

The cost-effectiveness of prostate cancer screening using the Stockholm3 test

et al. 2021

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Objectives The European Randomized Study of Screening for Prostate Cancer found that prostate-specific antigen (PSA) screening reduced prostate cancer mortality, however the costs and harms from screening may outweigh any mortality reduction. Compared with screening using the PSA test alone, using the Stockholm3 Model (S3M) as a reflex test for PSA ≥ 1 ng/mL has the same sensitivity for Gleason score ≥ 7 cancers while the relative positive fractions for Gleason score 6 cancers and no cancer were 0.83 and 0.56, respectively. The cost-effectiveness of the S3M test has not previously been assessed. Methods We undertook a cost-effectiveness analysis from a lifetime societal perspective. Using a microsimulation model, we simulated for: (i) no prostate cancer screening; (ii) screening using the PSA test; and (iii) screening using the S3M test as a reflex test for PSA values ≥ 1, 1.5 and 2 ng/mL. Screening strategies included quadrennial re-testing for ages 55–69 years performed by a general practitioner. Discounted costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. Results Comparing S3M with a reflex threshold of 2 ng/mL with screening using the PSA test, S3M had increased effectiveness, reduced lifetime biopsies by 30%, and increased societal costs by 0.4%. Relative to the PSA test, the S3M reflex thresholds of 1, 1.5 and 2 ng/mL had ICERs of 170,000, 60,000 and 6,000 EUR/QALY, respectively. The S3M test was more cost-effective at higher biopsy costs. Conclusions Prostate cancer screening using the S3M test for men with an initial PSA ≥ 2.0 ng/mL was cost-effective compared with screening using the PSA test alone.

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Section: Introductionmentioning

confidence: 99%

The cost-effectiveness of prostate cancer screening using the Stockholm3 test

et al. 2021

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“…view of economic evaluation (36)(37)(38)(39). Second, we could not access the full-texts of 3 records on the economic evaluation of esophageal cancer treatment (40)(41)(42); therefore, we inevitably excluded them.…”

Section: Discussionmentioning

confidence: 99%

Economic Evaluation of Treatments for Patients with Esophageal Cancer: A Systematic Review

et al. 2019

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Context: Esophageal cancer is considered as a malignant disease with fatal consequences worldwide. In cancers, it is the sixth most common cause of mortality in the world. Objectives:The aim of the current study was to assess the cost-effectiveness of esophageal cancer treatments by performing a systematic review. Data Sources:We conducted systematic searches in Medline through PubMed, Scopus, Cochran Library, EMBASE, and Web of Science databases. The search was limited to English language publications and studies published before July 17, 2018.Results: Of 2487 records, 14 articles met our inclusion criteria. Most were conducted in The United States of America (USA) and The United Kingdom (UK). The majority of the evaluations (8) followed a healthcare system perspective. Of 14 included studies, 4 compared esophagectomy with endoscopy treatment (ET), 2 compared esophagectomy with chemotherapy regimens, 2 contrasted chemotherapy regimens, and 5 studied compared palliative cares.Conclusions: Among all the assessed studies, the ET was more cost-effective than esophagectomy, but there were contradictory results in palliative care for the treatment of esophageal cancer.

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“…This is the rst study to identify cost-effectiveness models focused on screening and diagnostic strategies beyond standard PSA-based testing. One recent systematic review assessed model-based economic evaluations of PSA-based screening strategies only (67). This review also found signi cant variation in model pathways to re ect cancer progression in the ten included studies and limited and heterogenous evidence on quality of life.…”

Section: Comparison With Previous Reviewsmentioning

confidence: 94%

Systematic Review of cost-effectiveness models in prostate cancer: exploring new developments in testing and diagnosis

Keeney

Thom

Turner

et al. 2020

Preprint

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Background There is currently no formal prostate cancer screening programme in the UK. Early detection using age-based prostate-specific antigen (PSA) testing is unlikely to be cost-effective due to limited mortality benefit and harms associated with overdetection. However, the discovery of new prostate cancer specific biomarkers and more accurate diagnostic strategies (e.g. magnetic resonance imaging (MRI)) could improve the outcomes of screening. A systematic review was conducted to assess the evidence base on cost-effectiveness of such innovations and areas for further development. Methods To identify model-based economic evaluations of screening and diagnostic tests for prostate cancer, a systematic review of the literature using the NHS Economic Evaluation Database, Medline, EMBASE, HTA databases, NICE guidelines, and UK National Screening Committee guidance was carried out, between 2009 and 2019. Relevant data were extracted on study type, model inputs, modelling methods and cost-effectiveness conclusions and the results narratively synthesized. Results Sixteen studies were included in the review. Seven studies compared the cost-effectiveness of new urinary or blood biomarkers compared to each other or the PSA test and found the biomarkers e.g. the Prostate Health Index (PHI) and SelectMDx, to be the most cost-effective. Seven studies compared newer prostate biopsy methods, including MRI-guided, to TRUS guided biopsy and found MRI-guided methods to be most cost-effective. The newer detection methods showed a reduction in unnecessary biopsies and overtreatment. However, there was uncertainty around the most cost-effective pathway of follow-up strategies (MRI/biomarkers) in men who have a negative initial biopsy. Many studies did not model stage or grade of cancer, cancer progression or the entire testing, screening and treatment pathway. Very few studies fully accounted for uncertainty in their analysis. Conclusions This review brings together the cost-effectiveness literature for novel screening and testing methods used in the diagnosis of prostate cancer. Several limitations of the published models were identified. The models generally either compared new biomarkers or new imaging techniques which highlights the importance of future work in this area, as biomarkers and imaging are likely to be used in combination.

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Cost-effectiveness of prostate cancer screening: a systematic review of decision-analytical models

Cited by 35 publications

References 19 publications

The cost-effectiveness of prostate cancer screening using the Stockholm3 test

The cost-effectiveness of prostate cancer screening using the Stockholm3 test

Economic Evaluation of Treatments for Patients with Esophageal Cancer: A Systematic Review

Systematic Review of cost-effectiveness models in prostate cancer: exploring new developments in testing and diagnosis

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