Cost-effectiveness of Prostate Cancer Screening: A Simulation Study Based on ERSPC Data

作者：Eveline A.M. Heijnsdijk, Tiago M. de Carvalho, Anssi P. Auvinen, Marco Zappa, Vera J. Nelen, MACIEJ K. KWIATKOWSKI, Arnauld A. Villers, Álvaro Páez, Sue Moss, Teuvo L.J. Tammela, Florian Recker, L. Denis, Sigrid Carlsson, Elisabeth M. Wever, Chris H. Bangma, Fritz H. Schröder, Monique J. Roobol, Jonas Hugosson, Harry J. de Koning · 发表于：JNCI Journal of the National Cancer Institute · 年份：2014 · DOI：10.1093/jnci/dju366 · 被引用次数：161 · 研究领域：Prostate Cancer Diagnosis and Treatment、Prostate Cancer Treatment and Research、Global Cancer Incidence and Screening

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 ye...