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- Title
Cost-effectiveness of Prostate Cancer Screening: A Simulation Study Based on ERSPC Data.
- Authors
Heijnsdijk, E. A. M.; de Carvalho, T. M.; Auvinen, A.; Zappa, M.; Nelen, V.; Kwiatkowski, M.; Villers, A.; Páez, A.; Moss, S. M.; Tammela, T. L. J.; Recker, F.; Denis, L.; Carlsson, S.V.; Wever, E. M.; Bangma, C. H.; Schröder, F. H.; Roobol, M. J.; Hugosson, J.; de Koning, H. J.
- Abstract
Background: The results of the European Randomized Study of Screening for Prostate Cancer (ERSPC) trial showed a statistically significant 29% prostate cancer mortality reduction for the men screened in the intervention arm and a 23% negative impact on the life-years gained because of quality of life. However, alternative prostate-specific antigen (PSA) screening strategies for the population may exist, optimizing the effects on mortality reduction, quality of life, overdiagnosis, and costs. Methods: Based on data of the ERSPC trial, we predicted the numbers of prostate cancers diagnosed, prostate cancer deaths averted, life-years and quality-adjusted life-years (QALY) gained, and cost-effectiveness of 68 screening strategies starting at age 55 years, with a PSA threshold of 3, using microsimulation modeling. The screening strategies varied by age to stop screening and screening interval (one to 14 years or once in a lifetime screens), and therefore number of tests. Results: Screening at short intervals of three years or less was more cost-effective than using longer intervals. Screening at ages 55 to 59 years with two-year intervals had an incremental cost-effectiveness ratio of $73000 per QALY gained and was considered optimal. With this strategy, lifetime prostate cancer mortality reduction was predicted as 13%, and 33% of the screen-detected cancers were overdiagnosed. When better quality of life for the post-treatment period could be achieved, an older age of 65 to 72 years for ending screening was obtained. Conclusion: Prostate cancer screening can be cost-effective when it is limited to two or three screens between ages 55 to 59 years. Screening above age 63 years is less cost-effective because of loss of QALYs because of overdiagnosis.
- Subjects
PROSTATE cancer; CANCER-related mortality; QUALITY of life; PROSTATE-specific antigen; EARLY detection of cancer
- Publication
JNCI: Journal of the National Cancer Institute, 2014, Vol 107, Issue 1, p1
- ISSN
0027-8874
- Publication type
Article
- DOI
10.1093/jnci/dju366