Overdetection, overtreatment and costs in prostate-specific antigen screening for prostate cancer

• Published in: British journal of cancer Vol. 101; no. 11; pp. 1833 - 1838
• Main Authors: Heijnsdijk, E A M, der Kinderen, A, Wever, E M, Draisma, G, Roobol, M J, de Koning, H J
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-12-2009; Nature Publishing Group
• Subjects: Age; Aged; Antigens; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Biopsy; Cancer Research; Cancer therapies; Clinical Study; Computer Simulation; Costs; Costs and Cost Analysis - methods; Drug Resistance; Epidemiology; Health care expenditures; Humans; Male; Mass Screening - economics; Mass Screening - methods; Medical research; Medical sciences; Medical screening; Men; Metastasis; Middle Aged; Models, Statistical; Molecular Medicine; Mortality; Neoplasm Staging; Nephrology. Urinary tract diseases; Oncology; Prostate cancer; Prostate-Specific Antigen - blood; Prostate-Specific Antigen - economics; Prostatic Neoplasms - blood; Prostatic Neoplasms - economics; Prostatic Neoplasms - pathology; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland; United Kingdom > UK; Netherlands; overdetection; prostate cancer; screening; Costs; Urinary system disease; Prostate disease; Tumoral marker; Malignant tumor; Medical screening; Prostate specific antigen; Cancerology; Health economy; Economic aspect; Male genital diseases; Prostate cancer; Cancer
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/sj.bjc.6605422

Background:
Prostate cancer screening with prostate-specific antigen (PSA) has shown to reduce prostate cancer mortality in the European Randomised study of Screening for Prostate Cancer (ERSPC) trial. Overdetection and overtreatment are substantial unfavourable side effects with consequent healthcare costs. In this study the effects of introducing widespread PSA screening is evaluated.
Methods:
The MISCAN model was used to simulate prostate cancer growth and detection in a simulated cohort of 100 000 men (European standard population) over 25 years. PSA screening from age 55 to 70 or 75, with 1, 2 and 4-year-intervals is simulated. Number of diagnoses, PSA tests, biopsies, treatments, deaths and corresponding costs for 100 000 men and for United Kingdom and United States are compared.
Results:
Without screening 2378 men per 100 000 were predicted to be diagnosed with prostate cancer compared with 4956 men after screening at 4-year intervals. By introducing screening, the costs would increase with 100% to €60 695 000. Overdetection is related to 39% of total costs (€23 669 000). Screening until age 75 is relatively most expensive because of the costs of overtreatment.
Conclusion:
Introduction of PSA screening will increase total healthcare costs for prostate cancer substantially, of which the actual screening costs will be a small part.