大规模前列腺癌筛查的成本效益分析

A cost-benefit analysis of mass prostate cancer screening.

作者信息

Farabi Hiro, Moradi Najmeh, Ahmadzadeh Aziz, Aghamir Seyed Mohammad Kazem, Mohammadi Abdolreza, Rezapour Aziz

机构信息

Barts and the London Pragmatic Clinical Trials Unit, Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.

Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.

出版信息

Cost Eff Resour Alloc. 2024 May 5;22(1):37. doi: 10.1186/s12962-024-00553-0.

DOI:10.1186/s12962-024-00553-0

PMID:38705990

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11071254/

Abstract

BACKGROUND

Prostate cancer (PCa) causes a substantial health and financial burden worldwide, underscoring the need for efficient mass screening approaches. This study attempts to evaluate the Net Cost-Benefit Index (NCBI) of PCa screening in Iran to offer insights for informed decision-making and resource allocation.

METHOD

The Net Cost-Benefit Index (NCBI) was calculated for four age groups (40 years and above) using a decision-analysis model. Two screening strategies, prostate-specific antigen (PSA) solely and PSA with Digital Rectal Examination (DRE), were evaluated from the health system perspective. A retrospective assessment of 1402 prostate cancer (PCa) patients' profiles were conducted, and direct medical and non-medical costs were calculated based on the 2021 official tariff rates, patient records, and interviews. The monetary value of mass screening was determined through Willingness to Pay (WTP) assessments, which served as a measure for the benefit aspect.

RESULT

The combined PSA and DRE strategy of screening is cost-effective, yields up to $3 saving in costs per case and emerges as the dominant strategy over PSA alone. Screening for men aged 70 and above does not meet economic justification, indicated by a negative Net Cost-Benefit Index (NCBI). The 40-49 age group exhibits the highest net benefit, $13.81 based on basic information and $13.54 based on comprehensive information. Sensitivity analysis strongly supports the cost-effectiveness of the combined screening approach.

CONCLUSION

This study advocates prostate cancer screening with PSA and DRE, is economically justified for men aged 40-69. The results of the study recommend that policymakers prioritize resource allocation for PCa screening programs based on age and budget constraints. Men's willingness to pay, especially for the 40-49 age group which had the highest net benefit, leverages their financial participation in screening services. Additionally, screening services for other age groups, such as 50-54 or 55-59, can be provided either for free or at a reduced cost.

摘要

背景

前列腺癌（PCa）在全球造成了巨大的健康和经济负担，凸显了高效大规模筛查方法的必要性。本研究旨在评估伊朗前列腺癌筛查的净成本效益指数（NCBI），为明智的决策和资源分配提供见解。

方法

使用决策分析模型计算了四个年龄组（40岁及以上）的净成本效益指数（NCBI）。从卫生系统的角度评估了两种筛查策略，即单独使用前列腺特异性抗原（PSA）和PSA联合直肠指检（DRE）。对1402例前列腺癌（PCa）患者的资料进行了回顾性评估，并根据2021年官方收费标准、患者记录和访谈计算了直接医疗和非医疗费用。通过支付意愿（WTP）评估确定了大规模筛查的货币价值，该评估作为效益方面的衡量标准。

结果

PSA和DRE联合筛查策略具有成本效益，每例可节省高达3美元的成本，并且是比单独使用PSA更具优势的策略。70岁及以上男性的筛查不符合经济合理性，净成本效益指数（NCBI）为负表明了这一点。40-49岁年龄组的净效益最高，基于基本信息为13.81美元，基于综合信息为13.54美元。敏感性分析有力地支持了联合筛查方法的成本效益。

结论

本研究提倡对40-69岁男性进行PSA和DRE联合前列腺癌筛查，这在经济上是合理的。研究结果建议政策制定者根据年龄和预算限制，优先为前列腺癌筛查项目分配资源。男性的支付意愿，特别是对于净效益最高的40-49岁年龄组，有助于他们在筛查服务中的经济参与。此外，对于其他年龄组，如50-54岁或55-59岁，可以免费或降低成本提供筛查服务。