Economic evaluation of prostate cancer screening with PSA

International Journal of Urology (2008) 15, 285-288
This is a review article concerning the economic evaluation of PSA screening.

• Thre are four main forms of economic evaluation: cost description, cost-effectiveness analysis (CEA), cost-utility analysis (CUA) and cost-benefit analysis (CBA).
• What distinguishes CEA and CUA is its denominator, CEA being the natural units (costs per potentially curable disease, costss per life years gained), CUA being QALY. While CBA assigns monetary values to both costs and outcomes (which can be valued by willing to pay, WTP)
• Reviews of five descriptive cost studies and nine CEA/CUA studies, but no CBA study was found.
• At present, two types of cost-effectiveness ratios in CEA were used - cost per potentially curable cancer and cost per life year saved.
• CUA - $US 8400-$US 23100 per QALY gained (Thompson); $42000 per QALY for 50-year-old men (Krahn); $68.32 per QALY (Kobayashi) - the results are enormously disparate.
• Kobayashi's conclusion - biennial PSA testing if baseline PSA <= 3.0 ng/mL was the most cost-effective strategy, the cost-utility ratio being $63.37 per QALY.
• We cannot draw direct inference from cost descriptive studies.
• The appropriatenss of any healthcare service must be judged by CEA, CUA, CBA.
• However, due to advancement in the diagnosis and treatment, compare different studies may not be rational and fair.

The current evidence shows that potential advantages of PSA screening are yet too inconclusive to justify its costs.