Hao Shuang, Discacciati Andrea, Eklund Martin, Heintz Emelie, Östensson Ellinor, Elfström K Miriam, Clements Mark S, Nordström Tobias
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
JAMA Oncol. 2022 Nov 10;9(1):88-94. doi: 10.1001/jamaoncol.2022.5252.
The combination of prostate-specific antigen (PSA) testing with magnetic resonance imaging (MRI) for prostate cancer detection has rarely been evaluated in a screening context. The STHLM3-MRI screening-by-invitation study (NCT03377881) has reported the benefits of using MRI with subsequent combined targeted and standard biopsies compared with using standard biopsies alone.
To investigate the cost-effectiveness of prostate cancer screening using MRI with combined targeted and standard biopsies compared with standard biopsies alone among men aged 55 to 69 years in Sweden, based on evidence from the STHLM3-MRI study.
DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation study was conducted from a lifetime health care perspective using a microsimulation model to evaluate no screening and screening strategies among adult men in Sweden. Men aged 55 to 69 years in Sweden were simulated for no screening and screening strategies. Input parameters were obtained from the STHLM3-MRI study and recent reviews. One-way and probabilistic sensitivity analyses were performed in May 2022.
No screening, quadrennial PSA screening using standard biopsies alone, and MRI-based screening using combined targeted and standard biopsies.
The number of tests, incidence, deaths, costs, quality-adjusted life-years (QALY), and incremental cost-effectiveness ratios (ICERs) were estimated.
A total 603 men were randomized to the standard arm, 165 of these participants (27.4%) did not undergo standard biopsy; 929 men were randomized to the experimental arm, 111 (11.9%) of whom did undergo MRI or any biopsy. Compared with no screening, the screening strategies were associated with reduced lifetime prostate cancer-related deaths by 6% to 9%. Screening with MRI and the combined biopsies resulted in an ICER of US $53 736, which is classified as a moderate cost per QALY gained in Sweden. Relative to screening with standard biopsies alone, MRI-based screening reduced the number of both lifetime biopsies and overdiagnosis by approximately 50% and had a high probability of being cost-effective than the traditional PSA screening.
For prostate cancer screening, this economic evaluation study found that PSA testing followed by MRI with subsequent combined targeted and standard biopsies had a high probability to be more cost-effective compared with the traditional screening pathway using PSA and standard biopsy. MRI-based screening may be considered for early detection of prostate cancer in Sweden.
在筛查背景下，很少评估将前列腺特异性抗原（PSA）检测与磁共振成像（MRI）相结合用于前列腺癌检测的情况。斯德哥尔摩3-MRI邀请式筛查研究（NCT03377881）报告了与单独使用标准活检相比，使用MRI随后进行联合靶向活检和标准活检的益处。
基于斯德哥尔摩3-MRI研究的证据，调查在瑞典55至69岁男性中，使用MRI联合靶向活检和标准活检进行前列腺癌筛查与单独使用标准活检相比的成本效益。
设计、设置和参与者：这项经济评估研究从终身医疗保健的角度进行，使用微观模拟模型评估瑞典成年男性的不筛查和筛查策略。对瑞典55至69岁的男性进行不筛查和筛查策略的模拟。输入参数来自斯德哥尔摩3-MRI研究和近期综述。于2022年5月进行了单因素和概率敏感性分析。
不筛查、单独使用标准活检进行每四年一次的PSA筛查，以及使用联合靶向活检和标准活检进行基于MRI的筛查。
估计检测次数、发病率、死亡人数、成本、质量调整生命年（QALY）和增量成本效益比（ICER）。
共有603名男性被随机分配到标准组，其中165名参与者（27.4%）未接受标准活检；929名男性被随机分配到试验组，其中111名（11.9%）接受了MRI或任何活检。与不筛查相比，筛查策略使前列腺癌相关终身死亡人数减少了6%至9%。使用MRI和联合活检进行筛查的ICER为53736美元，在瑞典属于每获得一个QALY成本适中的情况。相对于单独使用标准活检进行筛查，基于MRI的筛查使终身活检次数和过度诊断次数均减少了约50%，并且比传统PSA筛查更有可能具有成本效益。
对于前列腺癌筛查，这项经济评估研究发现，与使用PSA和标准活检的传统筛查途径相比，先进行PSA检测，然后进行MRI及随后的联合靶向活检和标准活检，很有可能更具成本效益。在瑞典，可考虑采用基于MRI的筛查来早期发现前列腺癌。
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