The economics of prostate cancer screening

The introduction of prostate-specific antigen (PSA) testing for use in the early detection of prostate cancer has led to controversy regarding the appropriateness of prostate cancer screening and any subsequent treatment. Much of this controversy arises from concern over the increased health-care costs that may result from widespread screening. As cost control becomes a dominant concern in today's health-care system, practitioners must decide whether the expense of screening and resulting treatment is worth the expenditure of its limited health-care system, practitioners must decide whether the expense of screening and resulting treatment is worth the expenditure of its limited health-care resources. This review first discusses the effects that widespread PSA screening would have on health-care costs. The benefits that will be realized by the expenditure of these additional health-care dollars are much more difficult to quantify. Decision analysis models have been used to evaluate the effectiveness of prostate cancer screening and treatment and have found little or no benefit. The current review illustrates how assumptions used to construct these models influence their results. The authors present a quantitative analysis of the costs and benefits of prostate cancer screening and treatment. This type of analysis demonstrates that prostate cancer screening and treatment may be a very cost-effective health-care intervention. Although men 50 to 70 years old will potentially benefit the most from PSA screening, this benefit will not be realized until they are in their seventh or eight decade of life. Society must decide if the years of life saved in these men warrants the use of its limited health-care resources. This decision will be easier when randomized, controlled trials are available to quantify the costs and benefits of PSA screening.