A Cost-Utility Analysis of Prostate Cancer Screening in Australia
A Cost-Utility Analysis of Prostate Cancer Screening in Australia
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DOI：
10.1007/s40258-016-0278-6
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发表时间：
2017-02-01
影响因子：
3.6
通讯作者：
Gianduzzo, Troy
中科院分区：
文献类型：
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作者：
Keller, Andrew;Gericke, Christian;Gianduzzo, Troy
背景和目标 哥德堡基于人群的随机前列腺癌筛查试验表明，与年龄匹配的对照组相比，基于前列腺特异性抗原 (PSA) 的筛查可减少前列腺癌死亡率。利用本研究中的前列腺癌检出率，我们研究了针对澳大利亚 50-69 岁男性人群的类似基于 PSA 的筛查策略的临床和成本效益。方法从卫生系统的角度开发了包含马尔可夫过程的决策模型。基本情景将基于人群的筛查计划与当前的机会性筛查实践进行了比较。成本、效用价值、治疗模式和背景死亡率均来自澳大利亚数据。所有费用均根据 2015 年 7 月的澳元 (A$) 进行调整。另一种方案将系统筛查与机会性筛查进行比较，但优化了两组的主动监测 (AS) 吸收率。成本和收益采用 5% 的贴现率。进行单变量和概率敏感性分析以评估变量不确定性对模型结果的影响。结果我们的模型非常接近地复制了 Go " teborg 研究中前列腺癌的死亡人数和背景死亡率。PSA 筛查的每个质量调整生命年 (QALY) 的增量成本为 147,528 澳元。然而，对于获得的生命年 (LYG)，基于 PSA 的 筛查（A$45,890/LYG）似乎更有利。我们采用优化的 AS 的替代方案将成本效用提高至 45,881 澳元/QALY，筛查在 92% 的 AS 采用率下变得具有成本效益。两种建模情景对干预前后患者的效用以及所使用的贴现率最为敏感。 结论 与澳大利亚假设的支付意愿相比，基于 PSA 的筛查并不具有成本效益 门槛为 50,000 澳元/QALY。如果使用 LYG 作为相关结果，似乎更具成本效益，并且比在此基础上制定的澳大利亚乳腺癌筛查计划更具成本效益。 Optimised utilisation of AS increases the cost effectiveness of prostate cancer screening dramatically.
Background and Objectives The Goteborg randomised population-based prostate cancer screening trial demonstrated that prostate-specific antigen (PSA)-based screening reduces prostate cancer deaths compared with an age-matched control group. Utilising the prostate cancer detection rates from this study, we investigated the clinical and cost effectiveness of a similar PSA-based screening strategy for an Australian population of men aged 50-69 years.Methods A decision model that incorporated Markov processes was developed from a health system perspective. The base-case scenario compared a population-based screening programme with current opportunistic screening practices. Costs, utility values, treatment patterns and background mortality rates were derived from Australian data. All costs were adjusted to reflect July 2015 Australian dollars (A$). An alternative scenario compared systematic with opportunistic screening but with optimisation of active surveillance (AS) uptake in both groups. A discount rate of 5 % for costs and benefits was utilised. Univariate and probabilistic sensitivity analyses were performed to assess the effect of variable uncertainty on model outcomes.Results Our model very closely replicated the number of deaths from both prostate cancer and background mortality in the Go " teborg study. The incremental cost per qualityadjusted life-year (QALY) for PSA screening was A$147,528. However, for years of life gained (LYGs), PSA-based screening (A$45,890/LYG) appeared more favourable. Our alternative scenario with optimised AS improved cost utility to A$45,881/QALY, with screening becoming cost effective at a 92 % AS uptake rate. Both modelled scenarios were most sensitive to the utility of patients before and after intervention, and the discount rate used.Conclusion PSA-based screening is not cost effective compared with Australia's assumed willingness-to-pay threshold of A$50,000/QALY. It appears more cost effective if LYGs are used as the relevant outcome, and is more cost effective than the established Australian breast cancer screening programme on this basis. Optimised utilisation of AS increases the cost effectiveness of prostate cancer screening dramatically.