Cost-Effectiveness Analysis of Prostate Cancer Screening in the UK: A Decision Model Analysis Based on the CAP Trial.
Cost-Effectiveness Analysis of Prostate Cancer Screening in the UK: A Decision Model Analysis Based on the CAP Trial.
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DOI：
10.1007/s40273-022-01191-1
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发表时间：
2022-12
影响因子：
4.4
通讯作者：
Clements, Mark S.
中科院分区：
文献类型：
--
作者：
Keeney, Edna;Sanghera, Sabina;Martin, Richard M.;Gulati, Roman;Wiklund, Fredrik;Walsh, Eleanor, I;Donovan, Jenny L.;Hamdy, Freddie;Neal, David E.;Lane, J. Athene;Turner, Emma L.;Thom, Howard;Clements, Mark S.
英国、欧洲和北美的大多数指南都不建议组织全民前列腺癌筛查。基于前列腺特异性抗原的筛查可以降低前列腺癌特异性死亡率，但人们担心过度诊断、过度治疗和经济价值。因此，目的是评估英国八种潜在筛查策略的成本效益。我们使用基于个体的模拟模型进行成本效用分析。该模型是根据前列腺癌PSA检测聚类随机试验（CAP）的10年随访数据进行校准的。使用前列腺癌检测和治疗（ProtecT）试验的数据对治疗效果进行建模。参与者是一个假设的1000万英国男性人口，从30岁到死亡。策略是：不筛查；五种基于年龄的筛查策略；适应性筛查，初始前列腺特异性抗原水平< 1.5 ng/mL的男性每6年筛查一次，高于这一水平的男性每4年筛查一次；以及两种多基因风险分层筛查策略。对于前列腺特异性抗原≥3ng /mL的男性，我们假设使用活检前多参数磁共振成像，并结合经直肠超声引导和靶向活检。主要结果测量是从国民健康服务的角度预测终生成本和质量调整生命年。与不进行筛查相比，所有筛查策略都增加了成本，大多数筛查策略还增加了质量调整生命年。如果每个质量调整生命年的支付意愿阈值为2万英镑或3万英镑，那么在50岁时进行一次性筛查是最理想的，尽管这对所使用的效用估计很敏感。尽管多基因风险分层筛查策略并不在成本效益的前沿，但有证据表明，与其他基于年龄的策略相比，它们的成本效率更低。在前列腺特异性抗原为基础的策略比较中，在目前英国的支付意愿阈值下，只有50岁的一次性筛查具有潜在的成本效益。对CAP进行15年的额外随访可以减少筛查策略成本效益的不确定性。在线版本包含补充材料，可在10.1007/s40273-022-01191-1获得。
Most guidelines in the UK, Europe and North America do not recommend organised population-wide screening for prostate cancer. Prostate-specific antigen-based screening can reduce prostate cancer-specific mortality, but there are concerns about overdiagnosis, overtreatment and economic value. The aim was therefore to assess the cost effectiveness of eight potential screening strategies in the UK. We used a cost-utility analysis with an individual-based simulation model. The model was calibrated to data from the 10-year follow-up of the Cluster Randomised Trial of PSA Testing for Prostate Cancer (CAP). Treatment effects were modelled using data from the Prostate Testing for Cancer and Treatment (ProtecT) trial. The participants were a hypothetical population of 10 million men in the UK followed from age 30 years to death. The strategies were: no screening; five age-based screening strategies; adaptive screening, where men with an initial prostate-specific antigen level of < 1.5 ng/mL are screened every 6 years and those above this level are screened every 4 years; and two polygenic risk-stratified screening strategies. We assumed the use of pre-biopsy multi-parametric magnetic resonance imaging for men with prostate-specific antigen ≥ 3 ng/mL and combined transrectal ultrasound-guided and targeted biopsies. The main outcome measures were projected lifetime costs and quality-adjusted life-years from a National Health Service perspective. All screening strategies increased costs compared with no screening, with the majority also increasing quality-adjusted life-years. At willingness-to-pay thresholds of £20,000 or £30,000 per quality-adjusted life-year gained, a once-off screening at age 50 years was optimal, although this was sensitive to the utility estimates used. Although the polygenic risk-stratified screening strategies were not on the cost-effectiveness frontier, there was evidence to suggest that they were less cost ineffective than the alternative age-based strategies. Of the prostate-specific antigen-based strategies compared, only a once-off screening at age 50 years was potentially cost effective at current UK willingness-to-pay thresholds. An additional follow-up of CAP to 15 years may reduce uncertainty about the cost effectiveness of the screening strategies. The online version contains supplementary material available at 10.1007/s40273-022-01191-1.
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影响因子：
23.4
作者：
Loeb, Stacy;Bjurlin, Marc A.;Nicholson, Joseph;Tammela, Teuvo L.;Penson, David F.;Carter, H. Ballentine;Carroll, Peter;Etzioni, Ruth
通讯作者：
Etzioni, Ruth
影响因子：
39.2
作者：
Gulati R;Gore JL;Etzioni R
通讯作者：
Etzioni R
影响因子：
3.6
作者：
Etzioni, Ruth;Gulati, Roman;Penson, David F.
通讯作者：
Penson, David F.
DOI：
10.1056/nejmoa1801993
发表时间：
2018-05-10
期刊：
The New England journal of medicine
影响因子：
--
作者：
通讯作者：
--
影响因子：
8.8
作者：
Wever, E. M.;Hugosson, J.;Heijnsdijk, E. A. M.;Bangma, C. H.;Draisma, G.;de Koning, H. J.
通讯作者：
de Koning, H. J.