Presentation (CTI)

OBJECTIVES: Prostate cancer (PCa) incidence and mortality are increasing rapidly in China, with a critical challenge being late-stage diagnosis. While early detection through screening improves outcomes, the economic efficiency of population-based programs in China remains unquantified. This study evaluates the cost-effectiveness of a community-based PCa screening project conducted in Beijing.
METHODS: A decision tree combined with a Markov was developed to simulate the natural history of PCa. Cohorts were stratified by age (60-64, 65-69, 70-74, 75-79 years) and weighted according to Beijing’s demographic structure. The model simulated screening outcomes over 40-year horizons with annual cycles using a healthcare payer perspective. Incremental cost-effectiveness ratios (ICERs) were calculated against no screening, with effectiveness measured in quality-adjusted life-years (QALYs).
RESULTS: Within the actual screened cohort (60-69y: 5,138; 70-74y: 3,333; 75-79y: 1433), 1065 men test positive for prostate-specific antigen (PSA ≥4.0 ng/mL), leading to 538 magnetic resonance imaging (MRI), 308 positive MRI results, 148 biopsies, and 85 cancer diagnoses (61% localized, 33% locally advanced). Model projections per 100,000 men screened, weighted by Beijing's age structure, indicated an increase in diagnosed localized (+95 cases) and locally advanced (+17 cases) cancers, but a decrease in metastatic cancers (-63 cases) and prostate cancer-specific deaths (-8 deaths). The overall population-weighted ICER was ¥18925 per QALY gained, below Beijing's per capita GDP (threshold for cost-effectiveness). However, cost-effectiveness decreased sharply with age, and yielded no net health benefit in 75+y group.
CONCLUSIONS: Population-based prostate cancer screening in Beijing demonstrates cost-effectiveness. However, this economic efficiency is highly age-dependent. Screening programs should prioritize the 60-74 age group to maximize resource utilization and health impact.