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A Cost-Utility Analysis of Prostate Cancer Screening in Australia

Author

Listed:
  • Andrew Keller

    (University of Queensland
    The Wesley Private Hospital)

  • Christian Gericke

    (University of Queensland
    The Wesley Private Hospital)

  • Jennifer A. Whitty

    (University of Queensland)

  • John Yaxley

    (The Wesley Private Hospital)

  • Boon Kua

    (The Wesley Private Hospital)

  • Geoff Coughlin

    (The Wesley Private Hospital)

  • Troy Gianduzzo

    (University of Queensland
    The Wesley Private Hospital)

Abstract

Background and Objectives The Göteborg randomised population-based prostate cancer screening trial demonstrated that prostate-specific antigen (PSA)-based screening reduces prostate cancer deaths compared with an age-matched control group. Utilising the prostate cancer detection rates from this study, we investigated the clinical and cost effectiveness of a similar PSA-based screening strategy for an Australian population of men aged 50–69 years. Methods A decision model that incorporated Markov processes was developed from a health system perspective. The base-case scenario compared a population-based screening programme with current opportunistic screening practices. Costs, utility values, treatment patterns and background mortality rates were derived from Australian data. All costs were adjusted to reflect July 2015 Australian dollars (A$). An alternative scenario compared systematic with opportunistic screening but with optimisation of active surveillance (AS) uptake in both groups. A discount rate of 5 % for costs and benefits was utilised. Univariate and probabilistic sensitivity analyses were performed to assess the effect of variable uncertainty on model outcomes. Results Our model very closely replicated the number of deaths from both prostate cancer and background mortality in the Göteborg study. The incremental cost per quality-adjusted life-year (QALY) for PSA screening was A$147,528. However, for years of life gained (LYGs), PSA-based screening (A$45,890/LYG) appeared more favourable. Our alternative scenario with optimised AS improved cost utility to A$45,881/QALY, with screening becoming cost effective at a 92 % AS uptake rate. Both modelled scenarios were most sensitive to the utility of patients before and after intervention, and the discount rate used. Conclusion PSA-based screening is not cost effective compared with Australia’s assumed willingness-to-pay threshold of A$50,000/QALY. It appears more cost effective if LYGs are used as the relevant outcome, and is more cost effective than the established Australian breast cancer screening programme on this basis. Optimised utilisation of AS increases the cost effectiveness of prostate cancer screening dramatically.

Suggested Citation

  • Andrew Keller & Christian Gericke & Jennifer A. Whitty & John Yaxley & Boon Kua & Geoff Coughlin & Troy Gianduzzo, 2017. "A Cost-Utility Analysis of Prostate Cancer Screening in Australia," Applied Health Economics and Health Policy, Springer, vol. 15(1), pages 95-111, February.
    • Handle: RePEc:spr:aphecp:v:15:y:2017:i:1:d:10.1007_s40258-016-0278-6
    DOI: 10.1007/s40258-016-0278-6
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    References listed on IDEAS

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    1. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
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    1. Bromley, Hannah L. & Petrie, Dennis & Mann, G.Bruce & Nickson, Carolyn & Rea, Daniel & Roberts, Tracy E., 2019. "Valuing the health states associated with breast cancer screening programmes: A systematic review of economic measures," Social Science & Medicine, Elsevier, vol. 228(C), pages 142-154.

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