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A Cost-Utility Analysis of Prostate Cancer Screening in Australia

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Abstract

Background and Objectives

The Göteborg randomised population-based prostate cancer screening trial demonstrated that prostate-specific antigen (PSA)-based screening reduces prostate cancer deaths compared with an age-matched control group. Utilising the prostate cancer detection rates from this study, we investigated the clinical and cost effectiveness of a similar PSA-based screening strategy for an Australian population of men aged 50–69 years.

Methods

A decision model that incorporated Markov processes was developed from a health system perspective. The base-case scenario compared a population-based screening programme with current opportunistic screening practices. Costs, utility values, treatment patterns and background mortality rates were derived from Australian data. All costs were adjusted to reflect July 2015 Australian dollars (A$). An alternative scenario compared systematic with opportunistic screening but with optimisation of active surveillance (AS) uptake in both groups. A discount rate of 5 % for costs and benefits was utilised. Univariate and probabilistic sensitivity analyses were performed to assess the effect of variable uncertainty on model outcomes.

Results

Our model very closely replicated the number of deaths from both prostate cancer and background mortality in the Göteborg study. The incremental cost per quality-adjusted life-year (QALY) for PSA screening was A$147,528. However, for years of life gained (LYGs), PSA-based screening (A$45,890/LYG) appeared more favourable. Our alternative scenario with optimised AS improved cost utility to A$45,881/QALY, with screening becoming cost effective at a 92 % AS uptake rate. Both modelled scenarios were most sensitive to the utility of patients before and after intervention, and the discount rate used.

Conclusion

PSA-based screening is not cost effective compared with Australia’s assumed willingness-to-pay threshold of A$50,000/QALY. It appears more cost effective if LYGs are used as the relevant outcome, and is more cost effective than the established Australian breast cancer screening programme on this basis. Optimised utilisation of AS increases the cost effectiveness of prostate cancer screening dramatically.

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Author contributions

Dr. Andrew Keller created the models, performed the literature review and wrote the paper. Prof. Christian Gericke was involved in paper concept, model design and paper proofing. Assoc Prof. Jennifer Whitty was involved in model design and creation, proofing of paper and assistance with the health economic elements of the paper. Dr. John Yaxley, Dr. Boon Kua and Dr. Geoff Coughlin were involved in model design and proofing of the paper. Dr. Troy Gianduzzo was responsible for the model and paper concept and was involved in model design and paper proofing and literature review.

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Correspondence to Andrew Keller.

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This study was partially funded by a higher research scholarship from the University of Queensland (UQ). UQ did not have any influence on the subject matter of the study, model design or conclusions. No other external funding was received.

Conflict of interest

The authors, Dr. Andrew Keller, Prof. Christian Gericke, Assoc. Prof. Jennifer Whitty, Dr. John Yaxley, Dr. Boon Kua, Dr. Geoff Coughlin and Dr. Troy Gianduzzo, have no conflicts of interest to declare.

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Keller, A., Gericke, C., Whitty, J.A. et al. A Cost-Utility Analysis of Prostate Cancer Screening in Australia. Appl Health Econ Health Policy 15, 95–111 (2017). https://doi.org/10.1007/s40258-016-0278-6

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