OBJECTIVES: The most common method today of prostate cancer diagnosis is screening for Prostate Specific Antigen (PSA) followed by a Transrectal Ultrasound Guided-Biopsy (TRUSGB). Magnetic Resonance Imaging-Guided Biopsy (MRGB) is an available method that has shown potential in previous studies. The available screening methods showing potential to reduce unnecessary biopsies are 4Kscore, Prostate Health Index (PHI) and Prostarix. The aim of this study was to evaluate the cost-effectiveness of introducing these tests compared to the use of only TRUSGB or MRGB.

METHODS: To calculate the cost-effectiveness for the screening tests, a Markov model was developed to integrate new screening tests for prostate cancer. Quality-adjusted life years gained (QALY) and costs for the tests were estimated over a time horizon of 5, 10, 15 and 20 years. The model includes probabilities of not getting an initial biopsy due to the tests, getting a positive result on the biopsy and stratification in low and intermediate/high risk cancer. The rate of missed cancers of the test is also a part of the model, as well as direct medical costs.

RESULTS: Data for Prostarix was insufficient and more clinical utility studies are needed to model this without big uncertainties. Costs and cumulative effects in QALY were calculated for 10, 15 and 20 years for 4Kscore and PHI. The costs for 4Kscore were $8300, $10389 and $11995 for the different time spans and for PHI $11164, $14700 and $17419 respectively. The cumulative effects for 4Kscore were 4.38, 7.42, 9.42 and 10.59 QALY and for PHI they were 7.28, 9.18 and 10.25 respectively. Compared to the TRUSGB and MRGB strategies, the 4Kscore strategy was the dominating strategy, yet the PHI strategy demonstrated similar costs and QALYs as the TRUSBG strategy.

CONCLUSIONS: The new screening methods show potential in complementing the existing screening process for prostate cancer.