E A M Heijnsdijk1, T M de Carvalho2, A Auvinen2, M Zappa2, V Nelen2, M Kwiatkowski2, A Villers2, A Páez2, S M Moss2, T L J Tammela2, F Recker2, L Denis2, S V Carlsson2, E M Wever2, C H Bangma2, F H Schröder2, M J Roobol2, J Hugosson2, H J de Koning2. 1. Department of Public Health (EAMH, TMdC, EMW, HJdK) and Department of Urology (CHB, FHS, MJR), Erasmus Medical Center, Rotterdam, the Netherlands; Tampere School of Health Sciences, University of Tampere, Tampere, Finland (AA); Unit of Epidemiology, Institute for Cancer Prevention, Florence, Italy (MZ); Provinciaal Instituut voor Hygiëne, Antwerp, Belgium (VN, LD); Department of Urology, Kantonsspital Aarau, Aarau, Switzerland (MK, FR); Department of Urology, Centre Hospitalier Regional Universitaire, Lille, France (AV); Department of Urology, Hospital de Fuenlabrada, Madrid, Spain (AP); Centre for Cancer Prevention, Queen Mary University of London, UK (SMM); Department of Urology, Tampere University Hospital and University of Tampere, Tampere, Finland (TLJT); Oncology Center, Antwerp, Belgium (LD); Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden (SVC, JH); Memorial Sloan-Kettering Cancer Center, Department of Surgery (Urology), New York, NY (SVC). e.heijnsdijk@erasmusmc.nl. 2. Department of Public Health (EAMH, TMdC, EMW, HJdK) and Department of Urology (CHB, FHS, MJR), Erasmus Medical Center, Rotterdam, the Netherlands; Tampere School of Health Sciences, University of Tampere, Tampere, Finland (AA); Unit of Epidemiology, Institute for Cancer Prevention, Florence, Italy (MZ); Provinciaal Instituut voor Hygiëne, Antwerp, Belgium (VN, LD); Department of Urology, Kantonsspital Aarau, Aarau, Switzerland (MK, FR); Department of Urology, Centre Hospitalier Regional Universitaire, Lille, France (AV); Department of Urology, Hospital de Fuenlabrada, Madrid, Spain (AP); Centre for Cancer Prevention, Queen Mary University of London, UK (SMM); Department of Urology, Tampere University Hospital and University of Tampere, Tampere, Finland (TLJT); Oncology Center, Antwerp, Belgium (LD); Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden (SVC, JH); Memorial Sloan-Kettering Cancer Center, Department of Surgery (Urology), New York, NY (SVC).
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: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.
RCT Entities:
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: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.
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Authors: Anssi Auvinen; Sue M Moss; Teuvo L J Tammela; Kimmo Taari; Monique J Roobol; Fritz H Schröder; Chris H Bangma; Sigrid Carlsson; Gunnar Aus; Marco Zappa; Donella Puliti; Louis J Denis; Vera Nelen; Maciej Kwiatkowski; Marco Randazzo; Alvaro Paez; Marcos Lujan; Jonas Hugosson Journal: Clin Cancer Res Date: 2015-08-19 Impact factor: 12.531