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

Abstract

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.

Cost-effectiveness analysis of short biparametric magnetic resonance imaging protocol in men at risk of prostate cancer

“…We evaluated the cost-effectiveness of each strategy for three age groups with a different Pca prevalence. Several economic-based models assessed some hypothetical screening strategies based on PSA thresholds, in relation to age categories (11)(12)(13)(14)(15)(16). Our analysis, based on age and PSA stratification, try to better understand the potential impact of BP-MRI on QALY and costs.…”

Novel blood-based early cancer detection: diagnostics in development

“…62,63 There is less evidence for the cost-effectiveness of prostate cancer screening. 64 Results of one study found it would be cost-effective if offered every 4 years and only if those with low-grade cancers identified on screening were followed with active surveillance. 65 LCDs, and 2 LCDs expected to become final in early 2020.…”

Impact of PSA testing on secondary care costs in England and Wales: estimates from the Cluster randomised triAl of PSA testing for Prostate cancer (CAP)

“…The cost-effectiveness of prostate cancer screening based on population-wide PSA testing is also uncertain, although it is known that costs of treating prostate cancer are high [ 9 ]. The Finnish Randomised Study of Screening for Prostate Cancer (FinRSPC), part of the European Randomised Study of Screening for Prostate Cancer (ERSPC) [ 10 ], followed up over 80,000 men for 20 years, but concluded that, when overall mortality was considered, neither arm could be defined as cost-effective [ 11 ]. As policy makers are interested in costs and benefits over a whole life time horizon in a screening context (particularly for prostate cancer which can take many years to manifest symptoms, if at all, during a man’s natural lifetime [ 12 ]), modelling approaches to deriving estimates of value for money are typically preferred over trial-based analyses for decision-making purposes.…”