Highly conservative use of the prostate-specific antigen (PSA) test and biopsy referral is necessary for PSA screening to be cost-effective, according to a study published in JAMA Oncology.
Joshua A. Roth, Ph.D., from the Fred Hutchinson Cancer Research Center in Seattle, and colleagues evaluated the potential cost-effectiveness of plausible PSA screening strategies and assessed the value added by increased use of conservative management among low-risk, screen-detected cases.
The authors developed a microsimulation model of prostate cancer incidence and mortality and used a simulated contemporary cohort of U.S. men beginning at 40 years of age to undergo 18 strategies for PSA screening.
The researchers found that all 18 screening strategies were associated with increased life-years (LYs; range, 0.03 to 0.06) and costs ($263 to $1,371) versus no screening (cost range from $7,335 to $21,649 per LY). Using a contemporary treatment practices model, only strategies with biopsy referral for PSA levels higher than 10.0 ng/mL or age-dependent thresholds were associated with increased quality-adjusted life-years (QALYs; 0.002 to 0.004).
Only quadrennial screening of patients aged 55 to 69 years was potentially cost-effective in terms of cost per QALY (incremental cost-effectiveness ratio, $92,446). Using selective treatment practices, all strategies were associated with increased QALYs (0.002 to 0.004), and several strategies were potentially cost-effective in terms of cost per QALY (incremental cost-effectiveness ratio, $70,831 to $136,332).
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“For PSA screening to be cost-effective, it needs to be used conservatively and ideally in combination with a conservative management approach for low-risk disease,” the authors write.