COST-EFFECTIVENESS ANALYSIS IN EARLY DETECTION OF PROSTATE-CANCER - AN EVALUATION OF 6 SCREENING STRATEGIES IN A RANDOMLY SELECTED POPULATION OF 2,400 MEN

Based on the findings in an early detection study for prostate cancer [Gustafsson et al.: J Urol 148:1827-1831, 1992] using digital rectal examination (DRE), transrectal ultrasound (TRUS), and prostate-specific antigen (PSA), a cost-effectiveness analysis was performed based on 6 screening strategies, namely: 1) DRE of all individuals; 2) TRUS of all individuals; 3) DRE, TRUS, and PSA analysis followed by reexamination of individuals with PSAs greater than or equal to 7 ng/ml; 4) DRE of individuals with PSAs of greater than or equal to 4 ng/ml; 5) TRUS of individuals with PSAs of greater than or equal to 4 ng/ml; 6) DRE and PSA analysis followed by TRUS on individuals with PSAs greater than or equal to 4 ng/ml. The detection rates of prostate cancer using these 6 strategies were 2.4%, 3.3%, 3.6%, 2.0%, 2.6%, and 3.2%, respectively. Except for costs per detected cancer, costs were also calculated per detected small cancer (less than or equal to 1.5 cm) and per detected cancer treated for cure. The cost calculations were based on total costs, i.e., direct plus indirect costs. When the 6 strategies were compared, taking into account the detection rate of cancers treated for cure and cost-effectiveness with respect to cancers treated for cure, strategies 1), 2), 3), and 4) were ruled out as less favorable than the remaining 2 strategies. TRUS of individuals with PSAs greater than or equal to 4 ng/ml (strategy 5) was the most cost-effective strategy and detected 80% of the cancers actually treated for cure. Screening with DRE and PSA analysis followed by TRUS of individuals with PSAs greater than or equal to 4 ng/ml (strategy 6) had a somewhat lower cost-effectiveness, but detected 90% of the cancers treated for cure. (C) 1995 Wiley-Liss, Inc.