Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Swedish eScience Research Centre, Stockholm, Sweden.
PLoS One. 2021 Feb 25;16(2):e0246674. doi: 10.1371/journal.pone.0246674. eCollection 2021.
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.
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.
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.
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.
欧洲前列腺癌筛查随机研究发现，前列腺特异性抗原（PSA）筛查降低了前列腺癌死亡率，但筛查的成本和危害可能超过任何死亡率的降低。与单独使用 PSA 测试相比，使用斯德哥尔摩 3 模型（S3M）作为 PSA≥1ng/mL 的反射测试，对 Gleason 评分≥7 癌症的敏感性相同，而 Gleason 评分 6 癌症和无癌症的相对阳性分数分别为 0.83 和 0.56。S3M 测试的成本效益尚未得到评估。
我们从终生社会角度进行了成本效益分析。使用微模拟模型，我们模拟了以下情况：（i）无前列腺癌筛查；（ii）使用 PSA 测试进行筛查；（iii）使用 S3M 测试作为 PSA 值≥1、1.5 和 2ng/mL 的反射测试进行筛查。筛查策略包括 55-69 岁时由全科医生进行的每四年一次的重新测试。计算了贴现成本、质量调整生命年（QALY）和增量成本效益比（ICER）。
与 PSA 测试相比，S3M 具有更高的效果，将终生活检减少了 30%，并增加了 0.4%的社会成本。与 PSA 测试相比，S3M 反射阈值为 1、1.5 和 2ng/mL 的 ICER 分别为 170,000、60,000 和 6,000 欧元/QALY。在更高的活检成本下，S3M 测试更具成本效益。
与单独使用 PSA 测试相比，对于初始 PSA≥2.0ng/mL 的男性，使用 S3M 测试进行前列腺癌筛查具有成本效益。
