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...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2021-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0246674 |
| _version_ | 1818405532217638912 |
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| 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 |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-12-14T08:57:32Z |
| format | Article |
| id | doaj.art-595dd50b114243c0aa3c321fc831be59 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-14T08:57:32Z |
| publishDate | 2021-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-595dd50b114243c0aa3c321fc831be592022-12-21T23:08:53ZengPublic Library of Science (PLoS)PLoS ONE1932-62032021-01-01162e024667410.1371/journal.pone.0246674The cost-effectiveness of prostate cancer screening using the Stockholm3 test.Andreas A KarlssonShuang HaoAlexandra JauhiainenK Miriam ElfströmLars EgevadTobias NordströmEmelie HeintzMark S Clements<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.https://doi.org/10.1371/journal.pone.0246674 |
| spellingShingle | 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. PLoS ONE |
| title | 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_short | The cost-effectiveness of prostate cancer screening using the Stockholm3 test. |
| title_sort | cost effectiveness of prostate cancer screening using the stockholm3 test |
| url | https://doi.org/10.1371/journal.pone.0246674 |
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