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 language | English |
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Pages (from-to) | 7742-7750 |
Number of pages | 9 |
Journal | Cancer Medicine |
Volume | 9 |
Issue number | 20 |
Early online date | 19 Aug 2020 |
DOIs | |
Publication status | Published - 1 Oct 2020 |
Bibliographical note
Funding Information:This publication was made possible by Grant number 1U01CA199338 from National Cancer Institute as part of Cancer Intervention and Surveillance Modeling Network (CISNET). Its contents are solely the responsiblity of the authors and do not necessarily represent the official views of the National Cancer Institute.
Publisher Copyright:
© 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
Keywords
- harms and benefits; cost-effectiveness
- micro-simulation
- prostate cancer
- prostate-specific antigen (PSA) screening