Faculty of Social Sciences (Health Sciences), University of Tampere, FI-33014 Tampere, Finland.
Faculty of Social Sciences (Health Sciences), University of Tampere, FI-33014 Tampere, Finland.
Eur J Cancer. 2018 Apr;93:108-118. doi: 10.1016/j.ejca.2018.01.111. Epub 2018 Mar 20.
Few empirical analyses of the impact of organised prostate cancer (PCa) screening on healthcare costs exist, despite cost-related information often being considered as a prerequisite to informed screening decisions. Therefore, we estimate the differences in register-based costs of publicly funded healthcare in the two arms of the Finnish Randomised Study of Screening for Prostate Cancer (FinRSPC) after 20 years.
We obtained individual-level register data on prescription medications, as well as inpatient and outpatient care, to estimate healthcare costs for 80,149 men during the first 20 years of the FinRSPC. We compared healthcare costs for the men in each trial arm and performed statistical analysis.
For all men diagnosed with PCa during the 20-year observation period, mean PCa-related costs appeared to be around 10% lower in the screening arm (SA). Mean all-cause healthcare costs for these men were also lower in the SA, but differences were smaller than for PCa-related costs alone, and no longer statistically significant. For men dying from PCa, although the difference was not statistically significant, mean all-cause healthcare costs were around 10% higher. When analysis included all observations, cumulative costs were slightly higher in the CA; however, after excluding extreme values, cumulative costs were slightly higher in the SA.
No major cost impacts due to screening were apparent, but the FinRSPC's 20-year follow-up period is too short to provide definitive evidence at this stage. Longer term follow-up will be required to be better informed about the costs of, or savings from, introducing mass PCa screening.
尽管成本相关信息通常被认为是知情筛查决策的前提，但关于前列腺癌（PCa）筛查对医疗保健成本影响的实证分析却很少。因此，我们在芬兰前列腺癌筛查随机研究（FinRSPC）的 20 年后，估计了该研究两个分支中基于登记的公共资助医疗保健成本的差异。
我们获得了个人层面的处方药物以及住院和门诊护理的登记数据，以估算 FinRSPC 前 20 年内 80149 名男性的医疗保健成本。我们比较了每个试验组男性的医疗保健成本，并进行了统计分析。
在 20 年的观察期内所有被诊断为 PCa 的男性中，筛查组（SA）的 PCa 相关成本似乎低 10%左右。这些男性的全因医疗保健成本在 SA 中也较低，但差异小于 PCa 相关成本，且不再具有统计学意义。对于死于 PCa 的男性，尽管差异无统计学意义，但全因医疗保健成本约高 10%。当分析包括所有观察结果时，CA 中的累积成本略高；然而，在排除极端值后，SA 中的累积成本略高。
没有明显的筛查成本影响，但 FinRSPC 的 20 年随访期还太短，现阶段无法提供明确的证据。需要进行更长期的随访，以便更好地了解大规模 PCa 筛查的成本或节省。
