COST-EFFECTIVENESS ANALYSIS OF PROSTATE CANCER SCREENING WITH PSA TEST IN HIGH-RISK POPULATION IN CHINA

ABSTRACT Purpose Both National Comprehensive Cancer Network (NCCN) and Chinese guidelines recommend beginning prostate-specific antigen (PSA) screening for men aged 50 or 45 with a family history as they were at a higher risk of developing prostate cancer. Several model-based economic evaluations of PSA screening studies have been conducted, but with little evidence from China. The aim of this study was to conduct an economic evaluation of the cost-utility of PSA-based prostate cancer screening in Chinese men. Methods We developed a decision-tree and Markov model in Microsoft Excel® to compare 2 strategies that can be used to detect prostate cancer: (1) PSA-based screening followed by a biopsy, and (2) Non-PSA screening. We assumed that the patients would repeat screening in subsequent years if their first-year PSA value was higher than 4.0 ng/ml. The model adopted health care system perspective and life-time horizon. Screening efficacy, cost, utility, and long-term survival of prostate cancer were retrieved from published literature and physician surveys. Both quality-adjusted life year (QALY) and costs were discounted at an annual rate of 3.5%. Uncertainty was assessed by one-way and probabilistic sensitivity analyses. Our model also calculated the risk-to-benefit ratio as the ratio of overdiagnoses (biopsy without diagnosed) to prostate cancer related death prevented in different age groups. Findings The results suggested that PSA-based screening was cost-effective compared to no PSA screening, with an incremental cost-utility ratio (ICUR) of CNY 11,381 ($1,821USD/1480 EUR) per QALY. This value was less than the threshold of one-time GDP per capita in China CNY 70,892 ($11,343 USD/ 9,216 EUR). Sensitivity analyses confirmed the robustness of the results. The risk-to-benefit ratios of the 50-65 years old and the 65-80 years old age groups were 1.3 and 2.8, respectively. Implications PSA-based prostate cancer screening appears to be cost-effective in some high-risk Chinese males. PSA screening (PSA testing followed by MRI and biopsy if positive) can be recommended for 50-65 year-old Chinese men since this approach had the lowest risk-to-benefit ratio. The approach should be further adapted based on future updated data.