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 e xamination (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 a ll individuals; 3) DRE, TRUS, and PSA analysis followed by reexaminati on of individuals with PSAs greater than or equal to 7 ng/ml; 4) DRE o f individuals with PSAs of greater than or equal to 4 ng/ml; 5) TRUS o f individuals with PSAs of greater than or equal to 4 ng/ml; 6) DRE an d PSA analysis followed by TRUS on individuals with PSAs greater than or equal to 4 ng/ml. The detection rates of prostate cancer using thes e 6 strategies were 2.4%, 3.3%, 3.6%, 2.0%, 2.6%, and 3.2%, respective ly. Except for costs per detected cancer, costs were also calculated p er detected small cancer (less than or equal to 1.5 cm) and per detect ed cancer treated for cure. The cost calculations were based on total costs, i.e., direct plus indirect costs. When the 6 strategies were co mpared, 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 th e remaining 2 strategies. TRUS of individuals with PSAs greater than o r equal to 4 ng/ml (strategy 5) was the most cost-effective strategy a nd detected 80% of the cancers actually treated for cure. Screening wi th DRE and PSA analysis followed by TRUS of individuals with PSAs grea ter than or equal to 4 ng/ml (strategy 6) had a somewhat lower cost-ef fectiveness, but detected 90% of the cancers treated for cure. (C) 199 5 Wiley-Liss, Inc.