Cost-effectiveness of Prostate Cancer Screening: A Simulation Study Based on ERSPC Data
Cost-effectiveness of Prostate Cancer Screening: A Simulation Study Based on ERSPC Data
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DOI：
10.1093/jnci/dju366
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发表时间：
2015-01-01
影响因子：
10.3
通讯作者：
de Koning, H. J.
中科院分区：
文献类型：
--
作者：
Heijnsdijk, E. A. M.;de Carvalho, T. M.;de Koning, H. J.
欧洲前列腺癌筛查随机研究(ERSPC)试验的结果表明，在干预组中接受筛查的男性前列腺癌死亡率在统计上显著降低了29%，对因生活质量而增加的寿命年数产生了23%的负面影响。然而，人群中可能存在替代的前列腺特异性抗原(PSA)筛查策略，从而优化降低死亡率、生活质量、过度诊断和成本的效果。基于ERSPC试验的数据，我们使用微模拟建模预测了前列腺癌诊断数量、前列腺癌死亡避免、获得的寿命年和质量调整生命年(QALY)，以及从55岁开始的68种筛查策略的成本效益，PSA阈值为3。筛查策略因停止筛查的年龄和筛查间隔(一至14年或一生筛查一次)而异，因此测试次数不同。每隔三年或更短时间进行筛查比使用较长间隔更具成本效益。在55岁至59岁的筛查中，每隔两年进行一次筛查，每增加一次QALY的成本-效果比为73000美元，被认为是最佳的。通过这一策略，终生前列腺癌死亡率预计降低13%，筛查发现的癌症中有33%被过度诊断。当可以获得更好的治疗后生活质量时，结束筛查的老年年龄为65至72岁。如果前列腺癌筛查在55岁至59岁之间限制在两到三次筛查，则可以具有成本效益。63岁以上的筛查成本效益较低，因为过度诊断导致QALY丢失。
The results of the European Randomized Study of Screening for Prostate Cancer (ERSPC) trial showed a statistically significant 29% prostate cancer mortality reduction for the men screened in the intervention arm and a 23% negative impact on the life-years gained because of quality of life. However, alternative prostate-specific antigen (PSA) screening strategies for the population may exist, optimizing the effects on mortality reduction, quality of life, overdiagnosis, and costs.Based on data of the ERSPC trial, we predicted the numbers of prostate cancers diagnosed, prostate cancer deaths averted, life-years and quality-adjusted life-years (QALY) gained, and cost-effectiveness of 68 screening strategies starting at age 55 years, with a PSA threshold of 3, using microsimulation modeling. The screening strategies varied by age to stop screening and screening interval (one to 14 years or once in a lifetime screens), and therefore number of tests.Screening at short intervals of three years or less was more cost-effective than using longer intervals. Screening at ages 55 to 59 years with two-year intervals had an incremental cost-effectiveness ratio of $73000 per QALY gained and was considered optimal. With this strategy, lifetime prostate cancer mortality reduction was predicted as 13%, and 33% of the screen-detected cancers were overdiagnosed. When better quality of life for the post-treatment period could be achieved, an older age of 65 to 72 years for ending screening was obtained.Prostate cancer screening can be cost-effective when it is limited to two or three screens between ages 55 to 59 years. Screening above age 63 years is less cost-effective because of loss of QALYs because of overdiagnosis.