The cost-effectiveness of prostate cancer screening using the Stockholm3 test.

<h4>Objectives</h4>The European Randomized Study of Screening for Prostate Cancer found that prostate-specific antigen (PSA) screening reduced prostate cancer mortality, however the costs and harms from screening may outweigh any mortality reduction. Compared with screening using the PSA...

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Autores principales: Andreas A Karlsson, Shuang Hao, Alexandra Jauhiainen, K Miriam Elfström, Lars Egevad, Tobias Nordström, Emelie Heintz, Mark S Clements
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Publicado: Public Library of Science (PLoS) 2021
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spelling oai:doaj.org-article:595dd50b114243c0aa3c321fc831be592021-12-02T20:15:50ZThe cost-effectiveness of prostate cancer screening using the Stockholm3 test.1932-620310.1371/journal.pone.0246674https://doaj.org/article/595dd50b114243c0aa3c321fc831be592021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0246674https://doaj.org/toc/1932-6203<h4>Objectives</h4>The European Randomized Study of Screening for Prostate Cancer found that prostate-specific antigen (PSA) screening reduced prostate cancer mortality, however the costs and harms from screening may outweigh any mortality reduction. Compared with screening using the PSA test alone, using the Stockholm3 Model (S3M) as a reflex test for PSA ≥ 1 ng/mL has the same sensitivity for Gleason score ≥ 7 cancers while the relative positive fractions for Gleason score 6 cancers and no cancer were 0.83 and 0.56, respectively. The cost-effectiveness of the S3M test has not previously been assessed.<h4>Methods</h4>We undertook a cost-effectiveness analysis from a lifetime societal perspective. Using a microsimulation model, we simulated for: (i) no prostate cancer screening; (ii) screening using the PSA test; and (iii) screening using the S3M test as a reflex test for PSA values ≥ 1, 1.5 and 2 ng/mL. Screening strategies included quadrennial re-testing for ages 55-69 years performed by a general practitioner. Discounted costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated.<h4>Results</h4>Comparing S3M with a reflex threshold of 2 ng/mL with screening using the PSA test, S3M had increased effectiveness, reduced lifetime biopsies by 30%, and increased societal costs by 0.4%. Relative to the PSA test, the S3M reflex thresholds of 1, 1.5 and 2 ng/mL had ICERs of 170,000, 60,000 and 6,000 EUR/QALY, respectively. The S3M test was more cost-effective at higher biopsy costs.<h4>Conclusions</h4>Prostate cancer screening using the S3M test for men with an initial PSA ≥ 2.0 ng/mL was cost-effective compared with screening using the PSA test alone.Andreas A KarlssonShuang HaoAlexandra JauhiainenK Miriam ElfströmLars EgevadTobias NordströmEmelie HeintzMark S ClementsPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 2, p e0246674 (2021)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Andreas A Karlsson
Shuang Hao
Alexandra Jauhiainen
K Miriam Elfström
Lars Egevad
Tobias Nordström
Emelie Heintz
Mark S Clements
The cost-effectiveness of prostate cancer screening using the Stockholm3 test.
description <h4>Objectives</h4>The European Randomized Study of Screening for Prostate Cancer found that prostate-specific antigen (PSA) screening reduced prostate cancer mortality, however the costs and harms from screening may outweigh any mortality reduction. Compared with screening using the PSA test alone, using the Stockholm3 Model (S3M) as a reflex test for PSA ≥ 1 ng/mL has the same sensitivity for Gleason score ≥ 7 cancers while the relative positive fractions for Gleason score 6 cancers and no cancer were 0.83 and 0.56, respectively. The cost-effectiveness of the S3M test has not previously been assessed.<h4>Methods</h4>We undertook a cost-effectiveness analysis from a lifetime societal perspective. Using a microsimulation model, we simulated for: (i) no prostate cancer screening; (ii) screening using the PSA test; and (iii) screening using the S3M test as a reflex test for PSA values ≥ 1, 1.5 and 2 ng/mL. Screening strategies included quadrennial re-testing for ages 55-69 years performed by a general practitioner. Discounted costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated.<h4>Results</h4>Comparing S3M with a reflex threshold of 2 ng/mL with screening using the PSA test, S3M had increased effectiveness, reduced lifetime biopsies by 30%, and increased societal costs by 0.4%. Relative to the PSA test, the S3M reflex thresholds of 1, 1.5 and 2 ng/mL had ICERs of 170,000, 60,000 and 6,000 EUR/QALY, respectively. The S3M test was more cost-effective at higher biopsy costs.<h4>Conclusions</h4>Prostate cancer screening using the S3M test for men with an initial PSA ≥ 2.0 ng/mL was cost-effective compared with screening using the PSA test alone.
format article
author Andreas A Karlsson
Shuang Hao
Alexandra Jauhiainen
K Miriam Elfström
Lars Egevad
Tobias Nordström
Emelie Heintz
Mark S Clements
author_facet Andreas A Karlsson
Shuang Hao
Alexandra Jauhiainen
K Miriam Elfström
Lars Egevad
Tobias Nordström
Emelie Heintz
Mark S Clements
author_sort Andreas A Karlsson
title The cost-effectiveness of prostate cancer screening using the Stockholm3 test.
title_short The cost-effectiveness of prostate cancer screening using the Stockholm3 test.
title_full The cost-effectiveness of prostate cancer screening using the Stockholm3 test.
title_fullStr The cost-effectiveness of prostate cancer screening using the Stockholm3 test.
title_full_unstemmed The cost-effectiveness of prostate cancer screening using the Stockholm3 test.
title_sort cost-effectiveness of prostate cancer screening using the stockholm3 test.
publisher Public Library of Science (PLoS)
publishDate 2021
url https://doaj.org/article/595dd50b114243c0aa3c321fc831be59
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