A cost-effectiveness analysis of screening for carcinoma of the prostate by digital examination

While screening for carcinoma of the prostate by digital examination has been promoted as low in cost, safe, and effective, recent reviews have questioned its cost-effectiveness. Critical analysis has been lacking because of limited understanding of the preclinical phase of the disease and because of the absence of pertinent large-cohort data. We conducted a cost-effectiveness analysis of digital examination for prostate cancer using computer simulation of a large-cohort study. The simulation allowed for study of variations in critical assumptions about the disease and the screening procedure and keeps track of outcome descriptors such as total cost of the screening program and total years of life saved over the life of the cohort. Under assumptions favoring demonstrations of benefit from screening, modest increases in life expectancy were found in direct proportion to frequency and increasing costs of screening.