Cost-Effectiveness of Prostate Specific Antigen Screening in the United States: Extrapolating From the European Study of Screening for Prostate Cancer

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Abstract
Preliminary results of the European Randomized Study of Screening for Prostate Cancer showed a decrease in prostate cancer specific mortality associated with prostate specific antigen screening. We evaluated the cost-effectiveness of prostate specific antigen screening using data from the European Randomized Study of Screening for Prostate Cancer protocol when extrapolated to the United States. We used previously reported Surveillance, Epidemiology and End Results-Medicare data and a nationwide sample of employer provided estimates of costs of care for patients with prostate cancer. The European data were used in accordance with the study protocol to determine the costs and cost-effectiveness of prostate specific antigen screening. The lifetime cost of screening with prostate specific antigen, evaluating abnormal prostate specific antigen and treating identified prostate cancer to prevent 1 death from prostate cancer was $5,227,306 based on the European findings and extrapolated to the United States. If screening achieved a similar decrease in overall mortality as the decrease in prostate cancer specific mortality in the European study, such intervention would cost $262,758 per life-year saved. Prostate specific antigen screening reported in the European study would become cost effective when the lifelong treatment costs were below $1,868 per life-year, or when the number needed to treat was lowered to 21 or fewer men. The lifelong costs of screening protocols are determined by the cost of treatment with an insignificant contribution from screening costs. We established a model that predicts the minimal requirements that would make screening a cost-effective measure for population based implementation.