Tawfik A
Ont Health Technol Assess Ser. 2015 May 1;15(11):1-37. eCollection 2015.
The prostate-specific antigen (PSA) blood test has become widely used in Canada to test for prostate cancer (PC), the most common cancer among Canadian men. Data suggest that population-based PSA screening may not improve overall survival.
This analysis aimed to review existing economic evaluations of population-based PSA screening, determine current spending on opportunistic PSA screening in Ontario, and estimate the cost of introducing a population-based PSA screening program in the province.
A systematic literature search was performed to identify economic evaluations of population-based PSA screening strategies published from 1998 to 2013. Studies were assessed for their methodological quality and applicability to the Ontario setting. An original cost analysis was also performed, using data from Ontario administrative sources and from the published literature. One-year costs were estimated for 4 strategies: no screening, current (opportunistic) screening of men aged 40 years and older, current (opportunistic) screening of men aged 50 to 74 years, and population-based screening of men aged 50 to 74 years. The analysis was conducted from the payer perspective.
The literature review demonstrated that, overall, population-based PSA screening is costly and cost-ineffective but may be cost-effective in specific populations. Only 1 Canadian study, published 15 years ago, was identified. Approximately $119.2 million is being spent annually on PSA screening of men aged 40 years and older in Ontario, including close to $22 million to screen men younger than 50 and older than 74 years of age (i.e., outside the target age range for a population-based program). A population-based screening program in Ontario would cost approximately $149.4 million in the first year.
Estimates were based on the synthesis of data from a variety of sources, requiring several assumptions and causing uncertainty in the results. For example, where Ontario-specific data were unavailable, data from the United States were used.
PSA screening is associated with significant costs to the health care system when the cost of the PSA test itself is considered in addition to the costs of diagnosis, staging, and treatment of screen-detected PCs.
前列腺特异性抗原（PSA）血液检测在加拿大已被广泛用于检测前列腺癌（PC），前列腺癌是加拿大男性中最常见的癌症。数据表明，基于人群的PSA筛查可能无法提高总体生存率。
本分析旨在回顾现有的关于基于人群的PSA筛查的经济评估，确定安大略省机会性PSA筛查的当前支出，并估计在该省引入基于人群的PSA筛查计划的成本。
进行了系统的文献检索，以确定1998年至2013年发表的关于基于人群的PSA筛查策略的经济评估。评估了这些研究的方法学质量及其对安大略省情况的适用性。还进行了一项原始成本分析，使用了安大略省行政来源和已发表文献的数据。估计了4种策略的一年成本：不筛查、对40岁及以上男性进行当前（机会性）筛查、对50至74岁男性进行当前（机会性）筛查以及对50至74岁男性进行基于人群的筛查。该分析是从支付方的角度进行的。
文献综述表明，总体而言，基于人群的PSA筛查成本高昂且成本效益不佳，但在特定人群中可能具有成本效益。仅发现了15年前发表的1项加拿大研究。安大略省每年在对40岁及以上男性进行PSA筛查上的支出约为1.192亿加元，其中包括近2200万加元用于筛查50岁以下和74岁以上的男性（即超出基于人群计划的目标年龄范围）。安大略省基于人群的筛查计划在第一年的成本约为1.494亿加元。
估计基于多种来源数据的综合，需要几个假设，导致结果存在不确定性。例如，在没有安大略省特定数据的情况下，使用了美国的数据。
当除了筛查发现的前列腺癌的诊断、分期和治疗成本外，还考虑PSA检测本身的成本时，PSA筛查会给医疗保健系统带来巨大成本。
