Prostate cancer screening: what can we learn from randomised trials?

Auvinen, Anssi

doi:10.21037/tau.2017.12.13

Cited by 3 publications

(2 citation statements)

References 49 publications

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“…While modelling-based CEA can provide useful information, its results typically are highly dependent on both the data and the assumptions used, which may sometimes be flawed or inaccurate [13, 14]. The need for assumptions can be minimised and the data quality maximised by drawing conclusions directly from the results of a pragmatic randomised controlled trial; we take this approach here, benefiting, e.g., from Finland’s well established statutory health-care registries [15–17].…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness analysis of PSA-based mass screening: Evidence from a randomised controlled trial combined with register data

et al. 2019

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In contrast to earlier studies which have used modelling to perform cost-effectiveness analysis, this study links data from a randomised controlled trial with register data from nationwide registries to reveal new evidence on costs, effectiveness, and cost-effectiveness of organised mass prostate-cancer screening based on prostate-specific antigen (PSA) testing. Cost-effectiveness analyses were conducted with individual-level data on health-care costs from comprehensive registers and register data on real-world effectiveness from the two arms of the Finnish Randomised Study of Screening for Prostate Cancer (FinRSPC), following 80,149 men from 1996 through 2015. The study examines cost-effectiveness in terms of overall mortality and, in addition, in terms of diagnosed men’s mortality from prostate cancer and mortality with but not from prostate cancer. Neither arm of the FinRSPC was clearly more cost-effective in analysis in terms of overall mortality. Organised screening in the FinRSPC could be considered cost-effective in terms of deaths from prostate cancer: averting just over one death per 1000 men screened. However, even with an estimated incremental cost-effectiveness ratio of below 20,000€ per death avoided, this result should not be considered in isolation. This is because mass screening in this trial also resulted in increases in death with, but not from, prostate cancer: with over five additional deaths per 1000 men screened. Analysis of real-world data from the FinRSPC reveals new evidence of the comparative effectiveness of PSA-based screening after 20 years of follow-up, suggesting the possibility of higher mortality, as well as higher healthcare costs, for screening-arm men who have been diagnosed with prostate cancer but who do not die from it. These findings should be corroborated or contradicted by similar analyses using data from other trials, in order to reveal if more diagnosed men have also died in the screening arms of other trials of mass screening for prostate cancer.

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Section: Introductionmentioning

confidence: 99%

Cost-effectiveness analysis of PSA-based mass screening: Evidence from a randomised controlled trial combined with register data

et al. 2019

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“…Figure 5: Prostate cancer mortality from prostate cancer screening trial Adapted from Source: Auvinen A, Transl Androl Urol. 2018 (27). …”

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confidence: 99%

Prostate cancer screening in Thailand: cost-effectiveness analysis and budget impact evaluation

Romyen

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Objectives:�As public health insurance schemes in Thailand did not included prostate cancer screening in their benefits package, this study aimed to systematically gather�the effectiveness and explore the cost effectiveness of difference prostate cancer screening programs for the Thai population and find the financial impact for adapting prostate cancer strategy. Method: We perform systematic and network meta-analysis, health economic evaluation using Markov's model to compare four prostate cancer screening strategies�with no screening options.�And we perform budget impact analysis to assess the potential burden for adopting selected strategy. � Result: The result from systematic review and network meta-analysis suggest the difference of outcome between each prostate cancer screening strategies, ESRPC Scheme yield the most efficacy in term of�prostate cancer diagnosis rate (OR 1.65; 95%CI 1.60-1.71) and Goteborg scheme yield the most efficacy in term of� prostate cancer related death(OR 0.41; CI 0.31-0.56). Based on the pharmacoeconomic result simulated by Markov's model, ESRPC and Goteborg schemes compared to no screening strategy yield ICUR at 97,350 THB and 95,554 THB respectively while CAP Scheme and PLCO Schemes are dominated option.� For applying prostate cancer screening strategy (ESRPC Scheme), total budget impact per patients estimated for 5 years were 302.58, 601.92, 901.45, 1200.95 and 1500.64 THB respectively Conclusion:� Comparing to No Screening option, ESRPC scheme and Goteborg scheme is Cost Effectiveness strategy options. (ICUR Within threshold of 1XGDP (Around 150,000-200,000 THB). Applying ESRPC screening scheme will affect budget impact in Thailand which needed to weight with clinical benefit as screening will improve life year gained and QALY.

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Cancer screening and early diagnosis in low and middle income countries

Mandal

Basu

2018

Bundesgesundheitsbl

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Prostate cancer screening: what can we learn from randomised trials?

Cited by 3 publications

References 49 publications

Cost-effectiveness analysis of PSA-based mass screening: Evidence from a randomised controlled trial combined with register data

Cost-effectiveness analysis of PSA-based mass screening: Evidence from a randomised controlled trial combined with register data

Prostate cancer screening in Thailand: cost-effectiveness analysis and budget impact evaluation

Cancer screening and early diagnosis in low and middle income countries

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