Bristol Medical School, Population Health Sciences, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK.
Bristol Medical School, Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
BMC Health Serv Res. 2023 Jun 9;23(1):610. doi: 10.1186/s12913-023-09503-7.
Screening men for prostate cancer using prostate-specific antigen (PSA) testing remains controversial. We aimed to estimate the likely budgetary impact on secondary care in England and Wales to inform screening decision makers.
The Cluster randomised triAl of PSA testing for Prostate cancer study (CAP) compared a single invitation to men aged 50-69 for a PSA test with usual care (no screening). Routinely collected hospital care data were obtained for all men in CAP, and NHS reference costs were mapped to each event via Healthcare Resource Group (HRG) codes. Secondary-care costs per man per year were calculated, and cost differences (and population-level estimates) between arms were derived annually for the first five years following randomisation.
In the first year post-randomisation, secondary-care costs averaged across all men (irrespective of a prostate cancer diagnosis) in the intervention arm (n = 189279) were £44.80 (95% confidence interval: £18.30-£71.30) higher than for men in the control arm (n = 219357). Extrapolated to a population level, the introduction of a single PSA screening invitation could lead to additional secondary care costs of £314 million.
Introducing a single PSA screening test for men aged 50-69 across England and Wales could lead to very high initial secondary-care costs.
使用前列腺特异性抗原（PSA）检测对前列腺癌进行男性筛查仍然存在争议。我们旨在评估这对英国和威尔士二级保健的可能预算影响，为筛查决策者提供信息。
Cluster randomised triAl of PSA testing for Prostate cancer study（CAP）研究比较了对 50-69 岁男性进行一次 PSA 检测的单一邀请与常规护理（无筛查）。对 CAP 中的所有男性均获得了常规收集的医院护理数据，并通过医疗保健资源组（HRG）代码将 NHS 参考成本映射到每个事件。计算了每位男性每年的二级保健费用，并在随机分组后的前五年每年计算了两组之间的费用差异（和人群水平估计值）。
在随机分组后的第一年，干预组（n=189279）中所有男性（无论是否患有前列腺癌）的二级保健费用平均为 £44.80（95%置信区间：£18.30-£71.30），高于对照组（n=219357）。在人群水平上推算，引入单次 PSA 筛查可能会导致额外的二级保健费用 3.14 亿英镑。
在英格兰和威尔士为 50-69 岁男性引入单次 PSA 筛查测试可能会导致初始二级保健费用非常高。
