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

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246674 ◽  
Author(s):  
Andreas A. Karlsson ◽  
Shuang Hao ◽  
Alexandra Jauhiainen ◽  
K. Miriam Elfström ◽  
Lars Egevad ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Gleason Score ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Cost Effective ◽  
Psa Test ◽  
Life Years ◽  
The Cost

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.

scholarly journals Interpreting cost-effectiveness ratios in a cost-effectiveness analysis of risk-tailored prostate screening: A critique of Callender et al.

2020 ◽  
Vol 3 ◽  
pp. 23
Author(s):  
James F. O'Mahony
Keyword(s):  
Prostate Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Disease Risk ◽  
Prostate Cancer Screening ◽  
Absolute Risk ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
The Cost

Callender et al. recently published a model-based cost-effectiveness analysis of a risk-tailored approach to prostate cancer screening. It considers the costs and effects of prostate cancer screening offered to all men aged 55-69 without any risk selection and, alternatively, over a range of risk-tailored strategies in which screen eligibility is determined by a varying threshold of disease risk. The analysis finds that the strategy of screening men once they reach a 10-year absolute risk of disease of 5% or more is cost-effective in a UK context. I believe there are several problems with the study, mostly stemming from an incorrect interpretation of the cost-effectiveness estimates. I show that one reinterpretation of their results indicates that screening is much less cost-effective than the original analysis suggests, indicating that screening should be restricted to a much smaller group of higher risk men. More broadly, I explain the challenges of attempting to meaningfully reinterpret the originally published results due to the simulation of non-mutually exclusive intervention strategies. Finally, I consider the relevance of considering sufficient alternative screening intensities. This critique highlights the need for appropriate interpretation of cost-effectiveness results for policymakers, especially as risk stratification within screening becomes increasingly feasible.

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

2020 ◽  
Author(s):  
Edna Keeney ◽  
Howard Thom ◽  
Emma Turner ◽  
Richard M Martin ◽  
Josie Morley ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Cost Effectiveness ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Cost Effective ◽  
Economic Evaluations ◽  
Psa Testing ◽  
Mri Guided ◽  
The Cost

Abstract 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.

scholarly journals Interpreting cost-effectiveness ratios in a cost-effectiveness analysis of risk-tailored prostate screening: A critique of Callender et al.

2020 ◽  
Vol 3 ◽  
pp. 23
Author(s):  
James F. O'Mahony
Keyword(s):  
Prostate Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Disease Risk ◽  
Prostate Cancer Screening ◽  
Absolute Risk ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
The Cost

Callender et al. recently published a model-based cost-effectiveness analysis of a risk-tailored approach to prostate cancer screening. It considers the costs and effects of prostate cancer screening offered to all men aged 55-69 without any risk selection and, alternatively, over a range of risk-tailored strategies in which screen eligibility is determined by a varying threshold of disease risk. The analysis finds that the strategy of screening men once they reach a 10-year absolute risk of disease of 5% or more is cost-effective in a UK context. I believe there are several problems with the study, mostly stemming from an incorrect interpretation of the cost-effectiveness estimates. I show that one reinterpretation of their results indicates that screening is much less cost-effective than the original analysis suggests, indicating that screening should be restricted to a much smaller group of higher risk men. More broadly, I explain the challenges of attempting to meaningfully reinterpret the originally published results due to the simulation of non-mutually exclusive intervention strategies. Finally, I consider the relevance of considering sufficient alternative screening intensities. This critique highlights the need for appropriate interpretation of cost-effectiveness results for policymakers, especially as risk stratification within screening becomes increasingly feasible.

scholarly journals Prostate Cancer Screening in the Workplace

AAOHN Journal ◽  
1998 ◽  
Vol 46 (8) ◽  
pp. 379-384 ◽  
Author(s):  
Claire Snyder ◽  
Peggy N. Schrammel ◽  
Claudia B. Griffiths ◽  
Robert I. Griffiths
Keyword(s):  
Prostate Cancer ◽  
Cancer Screening ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Screening Tests ◽  
Test Results ◽  
Total Cost ◽  
Screening Programs ◽  
Psa Testing ◽  
The Cost

Recognition of the mortality and morbidity associated with prostate cancer has resulted in employer based screening programs. This retrospective cohort study identified the employer costs of prostate cancer screening and referrals due to abnormal test results. The subjects were 385 men enrolled in a workplace screening program at a single employer between 1993 and 1995. Screening consisted of digital rectal examination (DRE) annually for enrolled employees aged 40 years and older, plus annual prostate specific antigen (PSA) testing for those 50 and older, and those 40 and older and considered at high risk. Data related to the health care and lost productivity costs of screening and referrals for abnormal test results were collected and analyzed. The total cost of screening was $44,355, or approximately $56 per screening encounter (788 DREs; 437 PSAs). Abnormal screening tests resulted in 52 referrals. Upon further evaluation, 42% were found to have an enlargement, 29% a node, and 12% benign prostatic hyperplasia. Only one malignancy was found. The total cost of additional referrals was $31,815, or 42% of the cost of screening plus referrals. As the cost per screening encounter was low, prostate cancer screening in the workplace is an efficient alternative.

scholarly journals Does the reflexive measurement of free PSA have a role in a tertiary cancer centre?

2013 ◽  
Vol 4 (5) ◽  
pp. 317
Author(s):  
Christopher Allard ◽  
Paul Yip ◽  
Ivan Blasutig ◽  
Karen Hersey ◽  
Neil Fleshner
Keyword(s):  
Prostate Cancer ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Diagnostic Précoce ◽  
Psa Test ◽  
Total Cost ◽  
Cancer Centre ◽  
Free Psa ◽  
Psa Testing ◽  
The Cost

Purpose: The percent free prostate-specific antigen (PSA) may complementtotal PSA for prostate cancer screening, but is of no benefitfor monitoring patients with previous prostate cancer diagnoses. Atthe Princess Margaret Hospital, a tertiary cancer centre in Toronto,Ontario, Canada, PSA values in the range 4 to 10 ng/mL promptreflexive measurements of free PSA. We hypothesize that reflexivefree PSA testing at tertiary cancer centres generates unnecessarycosts as the test is often conducted on patients with previous diagnosesof prostate cancer.Materials and Methods: We reviewed all reflexive free PSA measurementsconducted on a random sample of 250 men in a 10-yearperiod at our institution. We determined the clinical indicationsfor the PSA tests which triggered reflexive free PSA measurementsto estimate the proportion of free PSA tests that are not clinicallyindicated.Results: We reviewed the 1099 reflexive free PSA measurementsfor the 250 subjects. Of these tests, 562 (51%) were triggered byPSA tests ordered for screening/early detection, and 537 (49%)for monitoring.Conclusions: Of all reflexive free PSA tests, 49% were unnecessary.We conducted 3022 free PSA tests, at a cost of $5.84 pertest (Can$); the tests were performed in 2009 at this institution fora total cost of $17 648.48, about 49% of which ($8647.76) likelyrepresents unnecessary annual costs. We suggest a trial of userselectableorder sets allowing physicians to choose whether toinclude reflexive free PSA measurements on a case-by-case basis.This policy might improve the cost-effectiveness of the PSA test attertiary cancer centres.Objectif : Le pourcentage d’antigène prostatique spécifique (APS)libre peut compléter la mesure de l’APS total dans le dépistagedu cancer de la prostate, mais il n’est d’aucune utilité pour lasurveillance de patients ayant déjà reçu un diagnostic de cancerde la prostate. À l’hôpital Princess Margaret, un centre de soinsoncologiques tertiaires de Toronto, en Ontario (Canada), un tauxd’APS se situant entre 4 et 10 ng/mL entraîne systématiquementune évaluation des taux d’APS libre. Nous avançons l’hypothèseque la mesure de l’APS libre dans les centres de soins oncologiquestertiaires entraîne des dépenses inutiles car ce test est souventmené chez des patients ayant déjà reçu un diagnostic de cancerde la prostate.Matériel et méthodes : Nous avons examiné tous les cas de mesurede l’APS libre effectuée dans un échantillon aléatoire de 250 hommessur une période de 10 ans à notre établissement. Nous avonsvérifié les indications cliniques liées aux mesures de l’APS ayantentraîné une mesure de l’APS libre afin d’évaluer la proportionde ces mesures de l’APS libre qui n’étaient pas justifiées sur leplan clinique.Résultats : Chez les 250 sujets, 1099 mesures de l’APS libre ont étéeffectuées. Sur ces tests, 562 (51 %) ont fait suite à des mesuresde l’APS prescrites à des fins de dépistage/diagnostic précoce, et537 (49 %) à des fins de surveillance.Conclusions : De toutes les mesures de l’APS libre, 49 % n’étaientpas nécessaires; 3022 tests de mesure de l’APS libre, au coût de5,84 $ par test, ont été effectués en 2009 à notre établissement,pour un coût total de 17 648,48 $, dont environ 49 % – pour unmontant de 8647,76 $ – représente selon toute apparence desdépenses inutiles. Nous suggérons d’établir une règle basée sur lejugement clinique et permettant aux médecins de choisir d’inclureou non la mesure de l’APS libre au cas par cas. Une telle politiquepourrait améliorer la rentabilité des mesures de l’APS dans lescentres de soins oncologiques tertiaires.

scholarly journals Prostate cancer screening with prostate-specific antigen (PSA) test: a clinical practice guideline

BMJ ◽  
2018 ◽  
pp. k3581 ◽  
Author(s):  
Kari A O Tikkinen ◽  
Philipp Dahm ◽  
Lyubov Lytvyn ◽  
Anja F Heen ◽  
Robin W M Vernooij ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Practice ◽  
Cancer Screening ◽  
Prostate Specific Antigen ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Psa Test

Is Proton Beam Therapy Cost Effective in the Treatment of Adenocarcinoma of the Prostate?

2007 ◽  
Vol 25 (24) ◽  
pp. 3603-3608 ◽  
Author(s):  
Andre Konski ◽  
William Speier ◽  
Alexandra Hanlon ◽  
J. Robert Beck ◽  
Alan Pollack
Keyword(s):  
Prostate Cancer ◽  
Cost Effectiveness ◽  
Proton Beam ◽  
Comprehensive Evaluation ◽  
Cost Effective ◽  
Proton Beam Therapy ◽  
Sensitivity Analyses ◽  
Beam Radiation ◽  
Life Years ◽  
The Cost

Purpose New treatments are introduced routinely into clinical practice without rigorous economic analysis. The specific aim of this study was to examine the cost effectiveness of proton beam radiation compared with current state-of-the art therapy in the treatment of patients with prostate cancer. Materials and Methods A Markov model was informed with cost, freedom from biochemical failure (FFBF), and utility data obtained from the literature and from patient interviews to compare the cost effectiveness of 91.8 cobalt gray equivalent (CGE) delivered with proton beam versus 81 CGE delivered with intensity-modulated radiation therapy (IMRT). The length of how many years the model was run, patient's age, probability of FFBF after treatment with proton beam therapy and IMRT, utility of patients treated with salvage hormone therapy, and treatment cost were tested in sensitivity analyses. Results Analysis at 15 years resulted in an expected mean cost of proton beam therapy and IMRT of $63,511 and $36,808, and $64,989 and $39,355 for a 70-year-old and 60-year-old man respectively, with quality-adjusted survival of 8.54 and 8.12 and 9.91 and 9.45 quality-adjusted life-years (QALY), respectively. The incremental cost effectiveness ratio was calculated to be $63,578/QALY for a 70-year-old man and $55,726/QALY for a 60-year-old man. Conclusion Even when based on the unproven assumption that protons will permit a 10-Gy escalation of prostate dose compared with IMRT photons, proton beam therapy is not cost effective for most patients with prostate cancer using the commonly accepted standard of $50,000/QALY. Consideration should be given to limiting the number of proton facilities to allow comprehensive evaluation of this modality.

Physician-Patient Discussions With African American Men About Prostate Cancer Screening

2007 ◽  
Vol 2 (2) ◽  
pp. 156-164 ◽  
Author(s):  
Louie E. Ross ◽  
Barbara D. Powe ◽  
Yhenneko J. Taylor ◽  
Daniel L. Howard
Keyword(s):  
Prostate Cancer ◽  
African American ◽  
Cancer Screening ◽  
African American Men ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Psa Test ◽  
Advantages And Disadvantages ◽  
Incidence And Mortality ◽  
Physician Patient

Prostate cancer is the second leading cancer killer in men. Men in general and African American men in particular face crucial decisions regarding prostate cancer screening and perhaps treatment for this disease. Major health organizations agree that men should discuss prostate cancer screening with their physicians or other health care professionals. The purpose of the study was to examine sociodemographic and other correlates of physician-patient discussions regarding the advantages and disadvantages of the prostate-specific antigen (PSA) test among African American men aged 40 or older. A majority of African American men reported having discussed the advantages and disadvantages of prostate cancer screening and/or testing with their physicians before ordering it, and physician-patient discussions about the PSA test were associated with increased screening in African American men. Inasmuch as African American men have greater prostate cancer incidence and mortality over other groups, future attempts should be made to find meaningful correlates of PSA screening and test use to help reduce the burden of this disease.

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