Overdetection, overtreatment and costs in prostate-specific antigen screening for prostate cancer.
Overdetection, overtreatment and costs in prostate-specific antigen screening for prostate cancer.
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DOI：
10.1038/sj.bjc.6605422
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发表时间：
2009-12-01
影响因子：
8.8
通讯作者：
de Koning, H. J.
中科院分区：
文献类型：
--
作者：
Heijnsdijk, E. A. M.;der Kinderen, A.;Wever, E. M.;Draisma, G.;Roobol, M. J.;de Koning, H. J.
在欧洲前列腺癌筛查随机研究（ERSPC）试验中，前列腺特异性抗原（PSA）前列腺癌筛查显示可以降低前列腺癌死亡率。过度检测和过度治疗是严重的不良副作用，随之而来的是医疗费用。本研究评估了广泛引入PSA筛查的效果。MISCAN模型用于模拟25年以上10万名男性（欧洲标准人群）的前列腺癌生长和检测。模拟从55岁到70岁或75岁的PSA筛查，间隔1年、2年和4年。比较了10万名男性以及英国和美国的诊断、PSA检测、活检、治疗、死亡人数和相应费用。未进行筛查的每10万人中预计有2378人被诊断为前列腺癌，而每4年进行筛查的每10万人中有4956人被诊断为前列腺癌。通过引入筛查，成本将增加100%，达到6069.5万欧元。过度检测占总成本的39%（2366.9万欧元）。由于过度治疗的成本，75岁之前的筛查相对来说是最昂贵的。PSA筛查的引入将大大增加前列腺癌的医疗保健总费用，而实际筛查费用只占其中的一小部分。
Prostate cancer screening with prostate-specific antigen (PSA) has shown to reduce prostate cancer mortality in the European Randomised study of Screening for Prostate Cancer (ERSPC) trial. Overdetection and overtreatment are substantial unfavourable side effects with consequent healthcare costs. In this study the effects of introducing widespread PSA screening is evaluated. The MISCAN model was used to simulate prostate cancer growth and detection in a simulated cohort of 100 000 men (European standard population) over 25 years. PSA screening from age 55 to 70 or 75, with 1, 2 and 4-year-intervals is simulated. Number of diagnoses, PSA tests, biopsies, treatments, deaths and corresponding costs for 100 000 men and for United Kingdom and United States are compared. Without screening 2378 men per 100 000 were predicted to be diagnosed with prostate cancer compared with 4956 men after screening at 4-year intervals. By introducing screening, the costs would increase with 100% to €60 695 000. Overdetection is related to 39% of total costs (€23 669 000). Screening until age 75 is relatively most expensive because of the costs of overtreatment. Introduction of PSA screening will increase total healthcare costs for prostate cancer substantially, of which the actual screening costs will be a small part.
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影响因子：
23.4
作者：
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通讯作者：
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