COST ANALYSES OF PROSTATE-CANCER SCREENING - FRAMEWORKS FOR DISCUSSION
COST ANALYSES OF PROSTATE-CANCER SCREENING - FRAMEWORKS FOR DISCUSSION
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DOI：
10.1016/s0022-5347(17)32405-9
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发表时间：
1994-11-01
影响因子：
6.6
通讯作者：
MURPHY, GP
中科院分区：
文献类型：
--
作者：
LITTRUP, PJ;GOODMAN, AC;MURPHY, GP
我们最近对前列腺癌早期检测的成本分析评估了各种前列腺特异性抗原（PSA）筛查方法的经济性能，检测了边际成本随时间的变化，并使用效益-成本计算作为进一步讨论的框架。接受者操作者特征分析最初建议PSA的最佳测试性能为2至3 ng。ml.当单独使用时，约3 ng./ ml.结合直肠指诊。然而，较低的PSA决策水平需要成本理由。边际成本分析表明，由于对偶发癌症的敏感性显著降低，到第3年直肠指检的使用显著减少。效益-成本等式承认，迄今为止，成本和概率的许多参数并不确定，但说明了供讨论的要点。对增量变化最敏感的成本参数按降序排列为筛查试验的特异性、从早期治疗中获得的益处和疾病的患病率。关于提高美国人口总体受益可能性的讨论应集中在这些参数上，以及社会和伦理影响。如果我们假设通过减少治疗选择或覆盖范围来减少未来用于晚期癌症护理的支出，则筛查不存在经济效益。如果我们还假设社会的潜在成本与任何收益都不大致接近，我们可能会通过有效地阻止对最高风险群体进行筛查来产生不适当的降低成本的尝试。也许最大的直接成本控制问题是最老年龄组中前列腺癌检测的显着增加，这些年龄组的死亡率或发病率获益的可能性最小。如果改进公共卫生教育，使人们认识到在最老年龄组或先前患有严重疾病的人中早期发现的适当性，目前可能节省费用。
Our recent cost analysis of prostate cancer early detection evaluated the economic performance of various prostate specific antigen (PSA) screening approaches, detected marginal cost variations with time and used a benefit-cost calculation as a framework for further discussion. Receiver operator characteristic analysis initially suggested an optimal test performance for PSA of 2 to 3 ng./ml. when used alone and at approximately 3 ng./ml. in combination with digital rectal examination. However, lower PSA decision levels require cost justifications. Marginal cost analysis demonstrated markedly decreased use of digital rectal examination by year 3 due to significantly lower sensitivity for incident cancer. The benefit-cost equation acknowledges that many parameters of cost and probability are not definitive to date yet illustrated major points for discussion. The cost parameters most sensitive to incremental change in decreasing order are the specificity of the screening test, benefits obtained from early therapy and prevalence of the disease. Discussions about improving the likelihood of overall benefit for the United States population should focus on these parameters, as well as social and ethical implications.If we assume minimized future expenditures for terminal cancer care via decreases in therapy choices or coverage, no economic benefit for screening exists. If we also assume that potential costs to society are not roughly approximated by any benefits, we may engender inappropriate attempts at cost reduction by effectively discouraging screening in the highest risk groups. Perhaps the greatest immediate cost control issue is the marked increase in prostate cancer detection in the oldest age groups who have the least likelihood of mortality or morbidity benefits. Current cost savings may be possible with improved public health education about the appropriateness of early detection in the oldest age groups or those with significant preexisting medical conditions.