Only Conservative PSA Testing is Cost-Effective

This article originally appeared here.
This includes less frequent screening and more restrictive biopsy referral criteria.
This includes less frequent screening and more restrictive biopsy referral criteria.

(HealthDay News) -- Highly conservative use of the prostate-specific antigen (PSA) test and biopsy referral is necessary for PSA screening to be cost-effective, according to a study published online March 24 in JAMA Oncology.

Joshua A. Roth, PhD, from the Fred Hutchinson Cancer Research Center in Seattle, and colleagues evaluated the potential cost-effectiveness of plausible PSA screening strategies and assessed the value added by increased use of conservative management among low-risk, screen-detected cases. The authors developed a microsimulation model of prostate cancer incidence and mortality and used a simulated contemporary cohort of US men beginning at 40 years of age to undergo 18 strategies for PSA screening.

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The researchers found that all 18 screening strategies were associated with increased life-years (LYs; range, 0.03 to 0.06) and costs ($263 to $1,371) versus no screening (cost range from $7,335 to $21,649 per LY). Using a contemporary treatment practices model, only strategies with biopsy referral for PSA levels higher than 10.0 ng/mL or age-dependent thresholds were associated with increased quality-adjusted life-years (QALYs; 0.002 to 0.004). Only quadrennial screening of patients aged 55 to 69 years was potentially cost-effective in terms of cost per QALY (incremental cost-effectiveness ratio, $92,446). Using selective treatment practices, all strategies were associated with increased QALYs (0.002 to 0.004), and several strategies were potentially cost-effective in terms of cost per QALY (incremental cost-effectiveness ratio, $70,831 to $136,332).

"For PSA screening to be cost-effective, it needs to be used conservatively and ideally in combination with a conservative management approach for low-risk disease," the authors write.

Sources

  1. Roth JA, Gulati R, Gore JL, Cooperberg MR, and Etzioni R. Economic Analysis of Prostate-Specific Antigen Screening and Selective Treatment Strategies. JAMA. doi:10.1001/jamaoncol.2015.6275.
    Vickers AJ. Does Prostate-Specific Antigen Screening Do More Good Than Harm? JAMA Oncol. doi:10.1001/jamaoncol.2015.6276.
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