Costs and benefits of early detection of prostatic cancer

During recent years prostatic cancer has emerged as an increasing health problem in many countries. However, there is reason to believe it can be cured if detected at an early stage while still confined to the prostate. An effective screening programme could thus alter the natural history of the disease and reduce the overall mortality. But the benefit of such a programme is still under debate. A pilot programme using rectal-digital examination to investigate organisational, social and economical aspects was carried out. This information was then used to estimate the consequences of routine prostatic screening in the Swedish health service with aid of a decision analysis model. The study shows that prostatic cancer screening by rectal-digital examination can be organized as an integral part of primary health care, with high acceptance by the public. The total economic burden of screening on the health care sector will be high. The total expected health care cost in Sweden for all diagnosed prostatic cancers during the next 2 years, without screening, was estimated to be 53 million USD (in 1989 prices). 1048 patients were expected to be offered some potentially curative therapy. With rectal-digital examination the total cost during the next 2 years would be 131 million USD and 6522 patients would be given treatment. Alternatively, with transurethral ultrasound examination, the total cost would be 174 million USD and 10275 patients would receive potentially curative therapy. The ultimate health benefits of potentially curative treatment remain uncertain. Until we have scientific evidence of the cost-effectiveness of this method the model presented for analysing the consequences of different strategies could well prove helpful in policymaking for this complex problem.