Benoit R M, Naslund M J
Division of Urology, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
Urol Clin North Am. 1997 May;24(2):451-8. doi: 10.1016/s0094-0143(05)70392-x.
Widespread PSA screening will increase overall health care costs. This increase will not result from the detection of clinically insignificant prostate cancer, but rather from the stage migration caused by prostate cancer screening. This stage migration will result in a larger percentage of men with prostate cancer undergoing early treatment options, which are more expensive than treatment of late disease. More importantly, early detection of prostate cancer will lead to treatment several years earlier than would have occurred otherwise. Because treatment then will be paid for in current rather than future dollars, the opportunity costs of money will make treatment costs resulting from PSA screening greater than treatment costs resulting from traditional detection. The critical question is what benefits will be obtained by the expenditure of these additional health care dollars. If early treatment of clinically localized cancer has little or no effect on cause-specific survival, the additional health care costs will have been spent only to limit eventual treatment of local symptoms in the screened men. If early treatment of prostate cancer can increase survival, the added expense is more worthwhile. Because there are not adequate data available to address this issue, several approaches have been used to develop models to estimate cost-effectiveness. Decision analysis models have been used to evaluate the effectiveness of prostate cancer screening and treatment and have found little or no benefit. The current review has demonstrated how assumptions used in the models can influence the results. Benoit et al also have constructed a model of the effectiveness and cost-effectiveness of prostate cancer, but in this study only concrete parameters such as cost, published complication rates, and survival data were used. This quantitative analysis demonstrated that prostate cancer screening is an effective and cost-effective health care intervention compared with currently accepted medical interventions. Although men aged 50 to 70 years will potentially benefit the most from PSA screening, this benefit will not be realized until these men are in their seventh and eighth decades of life. Society must decide if the years of life saved in these men warrants the use of its limited health care resources. This decision will be easier when randomized, controlled trials are available to quantify the costs and benefits of PSA screening.
广泛开展前列腺特异性抗原（PSA）筛查会增加总体医疗费用。费用增加并非源于检测出临床意义不显著的前列腺癌，而是前列腺癌筛查导致的分期迁移。这种分期迁移将使更大比例的前列腺癌患者接受早期治疗方案，而早期治疗方案比晚期疾病的治疗费用更高。更重要的是，前列腺癌的早期检测将导致治疗时间比不进行筛查的情况提前数年。由于那时的治疗费用将以当前而非未来的货币支付，资金的机会成本将使PSA筛查导致的治疗费用高于传统检测导致的治疗费用。关键问题是，花费这些额外的医疗费用能获得什么益处。如果对临床局限性癌症的早期治疗对特定病因生存率几乎没有影响，那么额外的医疗费用就只是用于减轻筛查男性最终的局部症状。如果前列腺癌的早期治疗能提高生存率，那么增加的费用就更值得。由于没有足够的数据来解决这个问题，人们采用了几种方法来建立模型以估计成本效益。决策分析模型已被用于评估前列腺癌筛查和治疗的效果，结果发现益处很少或没有益处。当前的综述表明了模型中使用的假设如何影响结果。贝努瓦等人也构建了一个前列腺癌有效性和成本效益的模型，但在这项研究中仅使用了成本、已公布的并发症发生率和生存数据等具体参数。这项定量分析表明，与目前公认的医疗干预措施相比，前列腺癌筛查是一种有效且具有成本效益的医疗保健干预措施。尽管50至70岁的男性可能从PSA筛查中获益最大，但这种益处要到这些男性七八十岁时才会显现。社会必须决定，在这些男性身上节省的寿命年数是否值得动用其有限的医疗资源。当有随机对照试验来量化PSA筛查的成本和效益时，这个决策会更容易。
