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The cost-effectiveness of prostate cancer screening using the Stockholm3 test

OBJECTIVES: The European Randomized Study of Screening for Prostate Cancer found that prostate-specific antigen (PSA) screening reduced prostate cancer mortality, however the costs and harms from screening may outweigh any mortality reduction. Compared with screening using the PSA test alone, using...

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Autores principales: Karlsson, Andreas A., Hao, Shuang, Jauhiainen, Alexandra, Elfström, K. Miriam, Egevad, Lars, Nordström, Tobias, Heintz, Emelie, Clements, Mark S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7906342/
https://www.ncbi.nlm.nih.gov/pubmed/33630863
http://dx.doi.org/10.1371/journal.pone.0246674
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author Karlsson, Andreas A.
Hao, Shuang
Jauhiainen, Alexandra
Elfström, K. Miriam
Egevad, Lars
Nordström, Tobias
Heintz, Emelie
Clements, Mark S.
author_facet Karlsson, Andreas A.
Hao, Shuang
Jauhiainen, Alexandra
Elfström, K. Miriam
Egevad, Lars
Nordström, Tobias
Heintz, Emelie
Clements, Mark S.
author_sort Karlsson, Andreas A.
collection PubMed
description OBJECTIVES: The European Randomized Study of Screening for Prostate Cancer found that prostate-specific antigen (PSA) screening reduced prostate cancer mortality, however the costs and harms from screening may outweigh any mortality reduction. Compared with screening using the PSA test alone, using the Stockholm3 Model (S3M) as a reflex test for PSA ≥ 1 ng/mL has the same sensitivity for Gleason score ≥ 7 cancers while the relative positive fractions for Gleason score 6 cancers and no cancer were 0.83 and 0.56, respectively. The cost-effectiveness of the S3M test has not previously been assessed. METHODS: We undertook a cost-effectiveness analysis from a lifetime societal perspective. Using a microsimulation model, we simulated for: (i) no prostate cancer screening; (ii) screening using the PSA test; and (iii) screening using the S3M test as a reflex test for PSA values ≥ 1, 1.5 and 2 ng/mL. Screening strategies included quadrennial re-testing for ages 55–69 years performed by a general practitioner. Discounted costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. RESULTS: Comparing S3M with a reflex threshold of 2 ng/mL with screening using the PSA test, S3M had increased effectiveness, reduced lifetime biopsies by 30%, and increased societal costs by 0.4%. Relative to the PSA test, the S3M reflex thresholds of 1, 1.5 and 2 ng/mL had ICERs of 170,000, 60,000 and 6,000 EUR/QALY, respectively. The S3M test was more cost-effective at higher biopsy costs. CONCLUSIONS: Prostate cancer screening using the S3M test for men with an initial PSA ≥ 2.0 ng/mL was cost-effective compared with screening using the PSA test alone.
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spelling pubmed-79063422021-03-03 The cost-effectiveness of prostate cancer screening using the Stockholm3 test Karlsson, Andreas A. Hao, Shuang Jauhiainen, Alexandra Elfström, K. Miriam Egevad, Lars Nordström, Tobias Heintz, Emelie Clements, Mark S. PLoS One Research Article OBJECTIVES: The European Randomized Study of Screening for Prostate Cancer found that prostate-specific antigen (PSA) screening reduced prostate cancer mortality, however the costs and harms from screening may outweigh any mortality reduction. Compared with screening using the PSA test alone, using the Stockholm3 Model (S3M) as a reflex test for PSA ≥ 1 ng/mL has the same sensitivity for Gleason score ≥ 7 cancers while the relative positive fractions for Gleason score 6 cancers and no cancer were 0.83 and 0.56, respectively. The cost-effectiveness of the S3M test has not previously been assessed. METHODS: We undertook a cost-effectiveness analysis from a lifetime societal perspective. Using a microsimulation model, we simulated for: (i) no prostate cancer screening; (ii) screening using the PSA test; and (iii) screening using the S3M test as a reflex test for PSA values ≥ 1, 1.5 and 2 ng/mL. Screening strategies included quadrennial re-testing for ages 55–69 years performed by a general practitioner. Discounted costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. RESULTS: Comparing S3M with a reflex threshold of 2 ng/mL with screening using the PSA test, S3M had increased effectiveness, reduced lifetime biopsies by 30%, and increased societal costs by 0.4%. Relative to the PSA test, the S3M reflex thresholds of 1, 1.5 and 2 ng/mL had ICERs of 170,000, 60,000 and 6,000 EUR/QALY, respectively. The S3M test was more cost-effective at higher biopsy costs. CONCLUSIONS: Prostate cancer screening using the S3M test for men with an initial PSA ≥ 2.0 ng/mL was cost-effective compared with screening using the PSA test alone. Public Library of Science 2021-02-25 /pmc/articles/PMC7906342/ /pubmed/33630863 http://dx.doi.org/10.1371/journal.pone.0246674 Text en © 2021 Karlsson et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Karlsson, Andreas A.
Hao, Shuang
Jauhiainen, Alexandra
Elfström, K. Miriam
Egevad, Lars
Nordström, Tobias
Heintz, Emelie
Clements, Mark S.
The cost-effectiveness of prostate cancer screening using the Stockholm3 test
title The cost-effectiveness of prostate cancer screening using the Stockholm3 test
title_full The cost-effectiveness of prostate cancer screening using the Stockholm3 test
title_fullStr The cost-effectiveness of prostate cancer screening using the Stockholm3 test
title_full_unstemmed The cost-effectiveness of prostate cancer screening using the Stockholm3 test
title_short The cost-effectiveness of prostate cancer screening using the Stockholm3 test
title_sort cost-effectiveness of prostate cancer screening using the stockholm3 test
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7906342/
https://www.ncbi.nlm.nih.gov/pubmed/33630863
http://dx.doi.org/10.1371/journal.pone.0246674
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