ECONOMIC EVALUATION OF PERCENT FREE PSA FOR PROSTATE CANCER DETECTION IN TAIWANESE MEN
Author(s)
LAI AY
ESSEC Business School Asia Pacific, Singapore, Singapore
OBJECTIVES The prevalence of prostate cancer in the Chinese population with abnormal prostate-specific antigen (PSA) levels of 4.0-10.0 ng/ml is low. The diagnosis can only rely on transrectal ultrasound-guided prostate biopsies (TRUS-Bx) which may cause major complications. We assess the cost-effectiveness of two diagnostic strategies for prostate cancer detection in Chinese men with abnormal PSA levels of 4.0-10.0 ng/ml and normal digital rectal examination of prostate (DRE). METHODS Using a decision tree model, we performed a cost-effectiveness analysis to compare the two strategies: 1) direct prostate biopsies (TRUS-Bx) and 2) percent free PSA testing prior to TRUS-Bx. A systematic review of 855 patients with PSA levels of 4.0-10.0 ng/ml and normal DRE enrolled in a single medical institute from Jan 2002 to December 2005 was conducted. The outcome measures were the incremental cost-effectiveness ratio, and costs were calculated through activity-accumulation costing based on National Insurance Scheme Bill Size. A one-way sensitivity analysis was undertaken. The effectiveness was measured by means of the number of detected cases and actual cases (detected cases minus lost cases). A threshold analysis is used to illustrate the value of a given variable of which the two strategies have equal outcomes or costs. RESULTS The strategy of percent free PSA with TRUS-Bx was dominant and found to be the most cost-effective. The incremental cost-effectiveness ratio for free PSA + TRUS-Bx compared with TRUS-Bx was USD 3,871.58. Strategy 2 (TRUS-Bx) would be more cost-effective if the cost of percent free PSA increased to USD 36.78 or if prostate cancer prevalence increased to 42%. CONCLUSIONS The use of percent free PSA prior to TRUS-Bx is the most cost-effective diagnostic strategy and will become more cost-effective as prostate cancer prevalence increases in the ageing population and the free PSA test costs down
Conference/Value in Health Info
2014-11, ISPOR Europe 2014, Amsterdam, The Netherlands
Value in Health, Vol. 17, No. 7 (November 2014)
Code
PUK18
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Urinary/Kidney Disorders