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Cost-effectiveness of prostate cancer screening: a simulation study based on ERSPC data
E A M Heijnsdijk1, T M de Carvalho2, A Auvinen2
1Department of Public Health (EAMH, TMdC, EMW, HJdK) and Department of Urology (CHB, FHS, MJR), Erasmus Medical Center, Rotterdam, the Netherlands; Tampere School of Health Sciences, University of Tampere, Tampere, Finland (AA); Unit of Epidemiology, Institute for Cancer Prevention, Florence, Italy (MZ); Provinciaal Instituut voor Hygiëne, Antwerp, Belgium (VN, LD); Department of Urology, Kantonsspital Aarau, Aarau, Switzerland (MK, FR); Department of Urology, Centre Hospitalier Regional Universitaire, Lille, France (AV); Department of Urology, Hospital de Fuenlabrada, Madrid, Spain (AP); Centre for Cancer Prevention, Queen Mary University of London, UK (SMM); Department of Urology, Tampere University Hospital and University of Tampere, Tampere, Finland (TLJT); Oncology Center, Antwerp, Belgium (LD); Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden (SVC, JH); Memorial Sloan-Kettering Cancer Center, Department of Surgery (Urology), New York, NY (SVC). e.heijnsdijk@erasmusmc.nl.
Optimizing prostate cancer screening strategies can reduce mortality and improve quality-adjusted life-years (QALYs). Limited screening between ages 55-59 with frequent intervals is most cost-effective, avoiding overdiagnosis and QALY loss.
Area of Science:
- Oncology
- Public Health
- Health Economics
Background:
- The European Randomized Study of Screening for Prostate Cancer (ERSPC) trial demonstrated a 29% reduction in prostate cancer mortality with screening.
- However, ERSPC also indicated a 23% negative impact on quality of life, highlighting the need for optimized screening strategies.
- Alternative prostate-specific antigen (PSA) screening approaches may balance mortality reduction, quality of life, overdiagnosis, and cost-effectiveness.
Purpose of the Study:
- To evaluate the cost-effectiveness of 68 different prostate cancer screening strategies using microsimulation modeling.
- To identify optimal screening parameters (age to stop, screening interval) for maximizing benefits and minimizing harms.
- To assess the impact of various screening strategies on prostate cancer mortality, overdiagnosis, quality-adjusted life-years (QALYs), and costs.
Main Methods:
- Microsimulation modeling based on data from the ERSPC trial.
- Prediction of prostate cancer incidence, mortality, QALYs gained, and cost-effectiveness for 68 distinct screening strategies.
- Strategies varied by age to stop screening (starting at 55 years) and screening interval (1-14 years or once-in-a-lifetime).
Main Results:
- Screening with intervals of three years or less was more cost-effective than longer intervals.
- An optimal strategy involved screening between ages 55-59 years with two-year intervals, yielding an incremental cost-effectiveness ratio of $73,000 per QALY gained.
- This optimal strategy predicted a 13% lifetime prostate cancer mortality reduction, with 33% of screen-detected cancers being overdiagnosed.
Conclusions:
- Prostate cancer screening can be cost-effective when limited to two or three screens between ages 55-59.
- Screening beyond age 63 is less cost-effective due to a significant loss of QALYs attributed to overdiagnosis.
- Optimized screening protocols are crucial for maximizing the benefits of prostate cancer screening while mitigating potential harms.
