S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
Prostate Cancer Prostatic Dis. 2020 Dec;23(4):615-621. doi: 10.1038/s41391-020-0243-1. Epub 2020 Jun 30.
Prostate-specific antigen (PSA) and prostate health index (PHI) have been used as biomarkers for prostate cancer detection. In this study, we aimed to evaluate the cost-effectiveness of PHI for prostate cancer detection in Chinese men.
We developed a Markov model for Chinese male patient aged 50-75 years old. The PSA strategy was to offer TRUS-PB for all patients with elevated PSA of 4-10 ng/mL. The PHI strategy was to offer PHI for patients with elevated PSA of 4-10 ng/mL. TRUS-PB would only be offered for patients with PHI >35.0. Model inputs were extracted from local data when available. The cost per quality-adjusted life years gained for both strategies were calculated. The incremental cost-effectiveness ratios in relation to the willingness-to-pay (WTP) threshold were compared. One-way sensitivity analysis and probabilistic sensitivity analysis were performed. Cost-effectiveness acceptability curves were also constructed.
With a Markov model of 25 screening cycles from age 50 to 75 years, the mean total costs per man were estimated to be USD 27,439 in the PSA strategy and USD 22,877 in the PHI strategy. The estimated effects were estimated to be 15.70 in the PSA strategy and 16.05 in the PHI strategy. The PHI strategy was associated with an expected decrease in cost of USD 4562 and an expected gain of 0.35 QALY, resulting in an ICER of USD -13056.56. The results were shown to be robust upon one-way sensitivity analysis. Upon Monte Carlo simulation, the PHI strategy was more cost-effective for 100% of the iterations. The PHI strategy demonstrated dominance over the PSA strategy regardless of what WTP threshold we use.
A PHI-based screening strategy may be more cost-effective than a PSA-based strategy for prostate cancer detection in Chinese men. These results support consideration of a PHI-based approach for prostate cancer in Hong Kong.
前列腺特异性抗原（PSA）和前列腺健康指数（PHI）已被用作前列腺癌检测的生物标志物。本研究旨在评估 PHI 在中国男性中用于前列腺癌检测的成本效益。
我们为年龄在 50-75 岁的中国男性患者开发了一个 Markov 模型。PSA 策略是为所有 PSA 升高至 4-10ng/ml 的患者提供经直肠超声引导下前列腺活检（TRUS-PB）。PHI 策略是为 PSA 升高至 4-10ng/ml 的患者提供 PHI。仅对 PHI>35.0 的患者提供 TRUS-PB。模型输入从当地数据中提取，如果有可用数据的话。计算了两种策略的每获得一个质量调整生命年的成本。比较了增量成本效益比与意愿支付（WTP）阈值的关系。进行了单因素敏感性分析和概率敏感性分析。还构建了成本效益可接受性曲线。
使用 50 至 75 岁 25 个筛查周期的 Markov 模型，估计 PSA 策略中每个男性的平均总成本为 27439 美元，PHI 策略为 22877 美元。估计 PSA 策略的效果为 15.70，PHI 策略为 16.05。PHI 策略预计将降低成本 4562 美元，获得 0.35 个 QALY，增量成本效益比为-13056.56 美元。单因素敏感性分析结果表明结果稳健。通过蒙特卡罗模拟，在 100%的迭代中，PHI 策略更具成本效益。无论我们使用什么 WTP 阈值，PHI 策略都优于 PSA 策略。
PHI 筛查策略可能比 PSA 筛查策略更具成本效益，用于中国男性的前列腺癌检测。这些结果支持在香港使用 PHI 方法进行前列腺癌筛查。
