Pataky Reka, Gulati Roman, Etzioni Ruth, Black Peter, Chi Kim N, Coldman Andrew J, Pickles Tom, Tyldesley Scott, Peacock Stuart
Cancer Control Research, BC Cancer Agency, Vancouver, BC, Canada; Canadian Centre for Applied Research in Cancer Control, Vancouver, BC, Canada.
Int J Cancer. 2014 Aug 15;135(4):939-47. doi: 10.1002/ijc.28732. Epub 2014 Feb 4.
Prostate-specific antigen (PSA) screening for prostate cancer may reduce mortality, but it incurs considerable risk of over diagnosis and potential harm to quality of life. Our objective was to evaluate the cost-effectiveness of PSA screening, with and without adjustment for quality of life, for the British Columbia (BC) population. We adapted an existing natural history model using BC incidence, treatment, cost and mortality patterns. The modeled mortality benefit of screening derives from a stage-shift mechanism, assuming mortality reduction consistent with the European Study of Randomized Screening for Prostate Cancer. The model projected outcomes for 40-year-old men under 14 combinations of screening ages and frequencies. Cost and utility estimates were explored with deterministic sensitivity analysis. The incremental cost-effectiveness of regular screening ranged from $36,300/LYG, for screening every four years from ages 55 to 69 years, to $588,300/LYG, for screening every two years from ages 40 to 74 years. The marginal benefits of increasing screening frequency to 2 years or starting screening at age 40 years were small and came at significant cost. After utility adjustment, all screening strategies resulted in a loss of quality-adjusted life years (QALYs); however, this result was very sensitive to utility estimates. Plausible outcomes under a range of screening strategies inform discussion of prostate cancer screening policy in BC and similar jurisdictions. Screening may be cost-effective, but the sensitivity of results to utility values suggests individual preferences for quality versus quantity of life should be a key consideration.
前列腺特异性抗原（PSA）筛查前列腺癌可能会降低死亡率，但会带来相当大的过度诊断风险以及对生活质量的潜在危害。我们的目标是评估在不列颠哥伦比亚省（BC）人群中，进行和不进行生活质量调整的PSA筛查的成本效益。我们采用BC省的发病率、治疗情况、成本和死亡率模式，对现有的自然史模型进行了调整。筛查的模拟死亡率益处源自阶段转移机制，假设死亡率降低情况与欧洲前列腺癌随机筛查研究一致。该模型预测了40岁男性在14种筛查年龄和频率组合下的结果。通过确定性敏感性分析探讨了成本和效用估计。定期筛查的增量成本效益范围从每获得一个生命年增益（LYG）36,300美元（55至69岁每四年筛查一次）到每获得一个LYG 588,300美元（40至74岁每两年筛查一次）。将筛查频率提高到两年或从40岁开始筛查的边际效益很小，且成本高昂。在进行效用调整后，所有筛查策略都会导致质量调整生命年（QALY）的损失；然而，这一结果对效用估计非常敏感。一系列筛查策略下的合理结果为BC省及类似司法管辖区的前列腺癌筛查政策讨论提供了参考。筛查可能具有成本效益，但结果对效用值的敏感性表明，个人对生活质量与数量的偏好应成为关键考虑因素。
