Is prostate cancer screening cost-effective? A microsimulation model of prostate-specific antigen-based screening for British Columbia, Canada

Reka Pataky, Roman Gulati, Ruth Etzioni, Peter Black, Kim N. Chi, Andrew J. Coldman, Tom Pickles, Scott Tyldesley, Stuart Peacock

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Prostate-specific antigen (PSA) screening for prostate cancer may reduce mortality, but it incurs considerable risk of over diagnosis and potential harm to quality of life. Our objective was to evaluate the cost-effectiveness of PSA screening, with and without adjustment for quality of life, for the British Columbia (BC) population. We adapted an existing natural history model using BC incidence, treatment, cost and mortality patterns. The modeled mortality benefit of screening derives from a stage-shift mechanism, assuming mortality reduction consistent with the European Study of Randomized Screening for Prostate Cancer. The model projected outcomes for 40-year-old men under 14 combinations of screening ages and frequencies. Cost and utility estimates were explored with deterministic sensitivity analysis. The incremental cost-effectiveness of regular screening ranged from 36,300/LYG, for screening every four years from ages 55 to 69 years, to 588,300/LYG, for screening every two years from ages 40 to 74 years. The marginal benefits of increasing screening frequency to 2 years or starting screening at age 40 years were small and came at significant cost. After utility adjustment, all screening strategies resulted in a loss of quality-adjusted life years (QALYs); however, this result was very sensitive to utility estimates. Plausible outcomes under a range of screening strategies inform discussion of prostate cancer screening policy in BC and similar jurisdictions. Screening may be cost-effective, but the sensitivity of results to utility values suggests individual preferences for quality versus quantity of life should be a key consideration.

Original languageEnglish (US)
Pages (from-to)939-947
Number of pages9
JournalInternational Journal of Cancer
Volume135
Issue number4
DOIs
StatePublished - Aug 15 2014
Externally publishedYes

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British Columbia
Prostate-Specific Antigen
Early Detection of Cancer
Canada
Prostatic Neoplasms
Costs and Cost Analysis
Mortality
Cost-Benefit Analysis
Quality of Life
Quality-Adjusted Life Years
Natural History
Health Care Costs
Incidence
Population

Keywords

  • cost-effectiveness
  • prostate cancer
  • PSA testing
  • screening

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Is prostate cancer screening cost-effective? A microsimulation model of prostate-specific antigen-based screening for British Columbia, Canada. / Pataky, Reka; Gulati, Roman; Etzioni, Ruth; Black, Peter; Chi, Kim N.; Coldman, Andrew J.; Pickles, Tom; Tyldesley, Scott; Peacock, Stuart.

In: International Journal of Cancer, Vol. 135, No. 4, 15.08.2014, p. 939-947.

Research output: Contribution to journalArticle

Pataky, R, Gulati, R, Etzioni, R, Black, P, Chi, KN, Coldman, AJ, Pickles, T, Tyldesley, S & Peacock, S 2014, 'Is prostate cancer screening cost-effective? A microsimulation model of prostate-specific antigen-based screening for British Columbia, Canada', International Journal of Cancer, vol. 135, no. 4, pp. 939-947. https://doi.org/10.1002/ijc.28732
Pataky, Reka ; Gulati, Roman ; Etzioni, Ruth ; Black, Peter ; Chi, Kim N. ; Coldman, Andrew J. ; Pickles, Tom ; Tyldesley, Scott ; Peacock, Stuart. / Is prostate cancer screening cost-effective? A microsimulation model of prostate-specific antigen-based screening for British Columbia, Canada. In: International Journal of Cancer. 2014 ; Vol. 135, No. 4. pp. 939-947.
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