Cost-effectiveness analysis of PSA-based mass screening: Evidence from a randomised controlled trial combined with register data


Autoři: Neill Booth aff001;  Pekka Rissanen aff001;  Teuvo L. J. Tammela aff002;  Paula Kujala aff003;  Ulf-Håkan Stenman aff005;  Kimmo Taari aff006;  Kirsi Talala aff007;  Anssi Auvinen aff001
Působiště autorů: Faculty of Social Sciences (Health Sciences), Tampere University, Tampere, Finland aff001;  Department of Urology, Tampere University Hospital, Tampere, Finland aff002;  Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland aff003;  Department of Pathology, Fimlab Laboratories, Tampere, Finland aff004;  Department of Clinical Chemistry and Haematology, University of Helsinki, Helsinki, Finland aff005;  Department of Urology, University of Helsinki, Helsinki, Finland aff006;  Finnish Cancer Registry, Helsinki, Finland aff007
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224479

Souhrn

In contrast to earlier studies which have used modelling to perform cost-effectiveness analysis, this study links data from a randomised controlled trial with register data from nationwide registries to reveal new evidence on costs, effectiveness, and cost-effectiveness of organised mass prostate-cancer screening based on prostate-specific antigen (PSA) testing. Cost-effectiveness analyses were conducted with individual-level data on health-care costs from comprehensive registers and register data on real-world effectiveness from the two arms of the Finnish Randomised Study of Screening for Prostate Cancer (FinRSPC), following 80,149 men from 1996 through 2015. The study examines cost-effectiveness in terms of overall mortality and, in addition, in terms of diagnosed men’s mortality from prostate cancer and mortality with but not from prostate cancer. Neither arm of the FinRSPC was clearly more cost-effective in analysis in terms of overall mortality. Organised screening in the FinRSPC could be considered cost-effective in terms of deaths from prostate cancer: averting just over one death per 1000 men screened. However, even with an estimated incremental cost-effectiveness ratio of below 20,000€ per death avoided, this result should not be considered in isolation. This is because mass screening in this trial also resulted in increases in death with, but not from, prostate cancer: with over five additional deaths per 1000 men screened. Analysis of real-world data from the FinRSPC reveals new evidence of the comparative effectiveness of PSA-based screening after 20 years of follow-up, suggesting the possibility of higher mortality, as well as higher healthcare costs, for screening-arm men who have been diagnosed with prostate cancer but who do not die from it. These findings should be corroborated or contradicted by similar analyses using data from other trials, in order to reveal if more diagnosed men have also died in the screening arms of other trials of mass screening for prostate cancer.

Klíčová slova:

Cancer detection and diagnosis – Cancer screening – Cost-effectiveness analysis – Death rates – Health economics – Prostate cancer – Randomized controlled trials – Finnish people


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