Assessment of harms, benefits, and cost-effectiveness of prostate cancer screening: A micro-simulation study of 230 scenarios

Abraham M. Getaneh* (Corresponding Author), Eveline A.M. Heijnsdijk, Monique J. Roobol, Harry J. de Koning

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)

Abstract

Background: Prostate cancer screening incurs a high risk of overdiagnosis and overtreatment. An organized and age-targeted screening strategy may reduce the associated harms while retaining or enhancing the benefits. Methods: Using a micro-simulation analysis (MISCAN) model, we assessed the harms, benefits, and cost-effectiveness of 230 prostate-specific antigen (PSA) screening strategies in a Dutch population. Screening strategies were varied by screening start age (50, 51, 52, 53, 54, and 55), stop age (51-69), and intervals (1, 2, 3, 4, 8, and single test). Costs and effects of each screening strategy were compared with a no-screening scenario. Results: The most optimum strategy would be screening with 3-year intervals at ages 55–64 resulting in an incremental cost-effectiveness ratio (ICER) of €19 733 per QALY. This strategy predicted a 27% prostate cancer mortality reduction and 28 life years gained (LYG) per 1000 men; 36% of screen-detected men were overdiagnosed. Sensitivity analyses did not substantially alter the optimal screening strategy. Conclusions: PSA screening beyond age 64 is not cost-effective and associated with a higher risk of overdiagnosis. Similarly, starting screening before age 55 is not a favored strategy based on our cost-effectiveness analysis.

Original languageEnglish
Pages (from-to)7742-7750
Number of pages9
JournalCancer Medicine
Volume9
Issue number20
Early online date19 Aug 2020
DOIs
Publication statusPublished - 1 Oct 2020

Keywords

  • harms and benefits; cost-effectiveness
  • micro-simulation
  • prostate cancer
  • prostate-specific antigen (PSA) screening

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