Background
Methods
Search strategy
Inclusion criteria
Study selection and data extraction
Results
Study type
Study | Setting | Population | Strategies compared | PSA threshold | Treatment | Outcome measure |
---|---|---|---|---|---|---|
Chilcott et al. [23] | UK | Men aged 50–74 | · single screen at 50 · screen every 4 years from 50 to 74 years · screen every 2 years 50–74 years · screen every year from 50 to 74 · screen at 50, 60, 65, 70 · screen every 4 years 50–70, 55–74, 55–70 · screen every 2 years 50–70, 55–74, 55–70 | 3.0 ng/ml 3.0 ng/ml 3.0 ng/ml 3.0 ng/ml 3.0 ng/ml 3.0 ng/ml 3.0 ng/ml | · prostatectomy with ADT · radiotherapy with ADT · prostatectomy without ADT · radiotherapy without ADT · watchful waiting · active monitoring | Cost per QALY gained |
Heijnsdijk et al. [25] | NR | Men aged 55–75 | 68 scenarios: | 3.0 ng/ml | · radiotherapy | Cost per QALY gained |
· starting at age 55; screen intervals at 1, 2, 3, 4, 6, 8, 10, 12, 14 years | 3.0 ng/ml | · prostatectomy | ||||
· once in a lifetime | 3.0 ng/ml | · active surveillance | ||||
· age at stopping was varied 55–75 years | 3.0 ng/ml | · metastases: palliative care | ||||
Hummel and Chilcott [24] | UK | Men aged 50–74 | · single screen at 50: | 3.0 ng/ml | · radiotherapy (with and without hormone therapy) | Cost per QALY gained |
· screen every 4 years from 50 to 74 years | 3.0 ng/ml | · prostatectomy (with and without hormone therapy) | ||||
· screen every 2 years 50–74 years | 3.0 ng/ml | · watchful waiting | ||||
· screen every year from 50 to 74 years | 3.0 ng/ml | · active monitoring | ||||
Keller et al. [29] | Australia | Men aged 50–69 | · opportunistic screening (current practice) · screen every 2 years from 50 to 69 years | 3.0 ng/ml to 2.5 ng/mla | · prostatectomy · radiotherapy · active surveillance | Cost per QALY gained |
3.0 ng/ml to 2.5 ng/mla | · watchful waiting One strategy with immediate treatment and one delayed based on Gleason score | Cost per life year gained | ||||
Kobayashi et al. [27] | NR | Men aged 50–70 | · annual screen irrespective of baseline | N/A | no details on exact nature of treatments | Cost per QALY gained |
· baseline PSA ≤ 1.0 ng/ml biennial rescreening | 1.0 ng/ml | |||||
· baseline PSA ≤ 2.0 ng/ml biennial rescreening | 2.0 ng/ml | |||||
· baseline PSA ≤ 3.0 ng/ml biennial rescreening | 3.0 ng/ml | |||||
· baseline PSA ≤ 4.0 ng/ml biennial rescreening | 4.0 ng/ml | |||||
Martin et al. [30] | Australia | Men aged 50- (unclear) | · average risk: screen every 4 years | 4.0 ng/ml | · radiotherapy (with and without hormone therapy) | Cost per QALY gained |
· high risk: screen every 4 years | 4.0 ng/ml | · prostatectomy (with and without hormone therapy) | ||||
· very high risk: screen every 4 years | 4.0 ng/ml | · conservative management | ||||
Pataky et al. [26] | Canada | Men aged 40–74 | 14 scenarios: | · radiotherapy (with and without hormone therapy) | Cost per QALY gained and | |
· Screen at 50, 60, 70 | 3.0 ng/ml | · prostatectomy (with and without hormone therapy) | ||||
· Screen at 60 followed by screen at 65 | 3.0 ng/ml | · conservative management | Cost per life year gained | |||
· screen every 4 years 55–69, 50–74 | 3.0 ng/ml | |||||
· screen every 4 years 50–74 | 3.0 ng/ml, (4.0 ng/ml for ≥70 years old) | |||||
· screen every 2 years 60–74, 50–69, 55–74, 50–74, 40–74 | 3.0 ng/ml | |||||
· screen every 2 years 50–74 | 3.0 ng/ml, (4.0 ng/ml for ≥70 years old) | |||||
· adaptive screen 50–74 | 3.0 ng/ml | |||||
Roth et al. [28] | US | Men aged 45–69 | 18 scenarios: | (1) all cases receive curative surgery, radiotherapy with or without adjuvant hormone therapy, | Cost per QALY gained and | |
· screen yearly 45–69, 50–74, 55–69 | 4.0 ng/ml | (2) Gleason < 7, <T2a receive conservative treatment or curative treatment, all others as above | ||||
· screen yearly 45–69, 50–74, 55–69 | 10.0 ng/ml | |||||
· screen yearly if >3.0 ng/ml, every 2 years otherwise,45–69 | 3.0 ng/ml | Cost per life year gained | ||||
· screen yearly if >3.0 ng/ml, every 2 years otherwise,45–69 | 10.0 ng/ml | |||||
· screen every 4 years 50–74 | 4.0 ng/ml | |||||
· screen every 4 years 50–74, 55–69 | 10.0 ng/ml | |||||
· screen every 2 years if >1.0 ng/ml, every 4 years otherwise, 50–74 | 4.0 ng/ml | |||||
· screen every 2 years if >1.0 ng/ml, every 4 years otherwise, 50–74 | 10.0 ng/ml | |||||
· screen yearly with age dependent threshold, 50–74 | 3.5(50–59), 4.5(60–69), 6.5(70–74) | |||||
· screen yearly with age dependent threshold 50–74 | 4.5(50–59), 5.5(60–69), 8.5(70–74) | |||||
· screen every 2 years 55–69 | 3.0 ng/ml | |||||
· screen every 4 years 55–69 | 3.0 ng/ml | |||||
· screen every 2 years 55–69 | 10.0 ng/ml | |||||
Wolstenholme et al. [31] | UK | Men aged 50–65 | · single screen at 50, 55, 60 and 65 | 3.0 ng/ml | active surveillance, prostatectomy, radiotherapy, orchidectomy, hormonal therapy, chemotherapy | Cost per life year saved/gained |
· screen every 5 years 50–65 | 3.0 ng/ml | |||||
Shteynshlyuger & Andriole, [22] | Europe | Men aged 60–70 | · “PSA screening reported in ERSPC”: | · Not reported. Assumed follows ERSPC trial | Cost per life year saved | |
· screen every 4 years | 3.0 ng/ml or 4.0 ng/ml (depending on the centre) | |||||
· no such screening | 3.0 ng/ml or 4.0 ng/ml (depending on the centre) |
Screening strategies
Study | Setting | Strategies compared | PSA threshold | ICER (Cost/QALY gained) | Threshold |
---|---|---|---|---|---|
Chilcott et al. [23] | UK | · single screen at 50 | 3.0 ng/ml | Dominateda | £20–30,000/QALY gained |
· screen every 4 years from 50 to 74 years | 3.0 ng/ml | Dominated | |||
· screen every 2 years 50–74 years | 3.0 ng/ml | Dominated | |||
· screen every year from 50 to 74 | 3.0 ng/ml | Dominated | |||
· screen at 50, 60, 65, 70 | 3.0 ng/ml | Dominated | |||
· screen every 4 years 50–70, 55–74, 55–70 | 3.0 ng/ml | Dominated | |||
· screen every 2 years 50–70, 55–74, 55–70 | 3.0 ng/ml | Dominated | |||
Heijnsdijk et al. [25] Costs in US dollars | NR | 68 scenarios (efficient strategies only): | 3.0 ng/ml | No formal threshold | |
· single screen at 55 years
|
3.0 ng/ml
|
$31,467
| |||
· screen at 55 and then 57 years | 3.0 ng/ml | $38,563 | |||
· screen at 55 and then 58 years | 3.0 ng/ml | $40,785 | |||
· screen every 2 years 55–59 years | 3.0 ng/ml | $45,615 | |||
· screen every 2 years 55–61 years | 3.0 ng/ml | $54,349 | |||
· screen yearly 55–61 years | 3.0 ng/ml | $63,263 | |||
· screen yearly 55–62 years | 3.0 ng/ml | $69,481 | |||
· screen yearly 55–63 years | 3.0 ng/ml | $76,910 | |||
Hummel and Chilcott [24] | UK | · single screen at 50 | 3.0 ng/ml | Dominated | £20–30,000/QALY gained |
· screen every 4 years from 50 to 74 years | 3.0 ng/ml | Dominated | |||
· screen every 2 years 50–74 years | 3.0 ng/ml | Dominated | |||
· screen every year from 50 to 74 years | 3.0 ng/ml | Dominated | |||
Keller et al. [29] | Australia | · opportunistic screening (current practice) | 3.0 ng/ml to 2.5 ng/ml | A$50,000/QALY gained | |
· screen every 2 years from 50 to 69 years (immediate treatment) | 3.0 ng/ml to 2.5 ng/ml | A$147,528 | |||
· screen every 2 years from 50 to 69 years (AS for low risk cancer)
|
A$45,882
| ||||
Kobayashi et al. [27] Costs in US dollars | NR | · annual screen irrespective of baseline, 50–70 | N/A | $165,938 | No formal threshold |
· baseline PSA ≤ 1.0 ng/ml biennial rescreening, 50–70 | 1.0 ng/ml | $46,505 | |||
· baseline PSA ≤ 2.0 ng/ml biennial rescreening, 50–70 | 2.0 ng/ml | $5925 | |||
· baseline PSA ≤ 3.0 ng/ml biennial rescreening, 50–70 | 3.0 ng/ml | ||||
· baseline PSA ≤ 4.0 ng/ml biennial rescreening. 50–70 | 4.0 ng/ml | Dominated | |||
Martin et al. [30] | Australia | · average risk screen: every 4 years, 50+ | 4.0 ng/ml | A$291,817 | A$50,000/QALY gained |
· high risk screen: every 4 years, 50+ | 4.0 ng/ml | A$110,726 | |||
· very high risk screen: every 4 years, 50+
|
4.0 ng/ml
|
A$30,572
| |||
Pataky et al. [26] | Canada | 14 scenarios: | CAN $50–80,000/QALY gained | ||
· screen at 50, 60, 70 | 3.0 ng/ml | Dominated | |||
· screen at 60 followed by screen at 65 | 3.0 ng/ml | Dominated | |||
· screen every 4 years 55–69, 50–74 | 3.0 ng/ml | Dominated | |||
· screen every 4 years 50–74 | 3.0 ng/ml, (4.0 ng/ml for ≥70 years old) | Dominated | |||
· screen every 2 years 60–74, 50–69, 55–74, 50–74, 40–74 | 3.0 ng/ml | Dominated | |||
· screen every 2 years 50–74 | 3.0 ng/ml, (4.0 ng/ml for ≥70 years old) | Dominated | |||
· adaptive screen 50–74 | 3.0 ng/ml | Dominated | |||
Roth et al. [28] | US | 18 scenarios: Contemporary treatment scenario | |||
· screen yearly 45–69, 50–74, 55–69 | 4.0 ng/ml | Dominated | US$ 50,000-150,000/QALY gained typically referred to (study refers to $150,000/QALY gained) | ||
· screen yearly 45–69 | 10.0 ng/ml | US $326,292 | |||
· screen yearly 50–74 | 10.0 ng/ml | US $330,065 | |||
· screen yearly 55–69 | 10.0 ng/ml | US $300,884 | |||
· screen yearly if >3.0 ng/ml, every 2 years otherwise,45–69 | 3.0 ng/ml | Dominated | |||
· screen yearly if >3.0 ng/ml, every 2 years otherwise,45–69 | 10.0 ng/ml | US $184,074 | |||
· screen every 4 years 50–74 | 4.0 ng/ml | Dominated | |||
· screen every 4 years 50–74 | 10.0 ng/ml | US $170,195 | |||
· screen every 4 years 55–69
|
10.0 ng/ml
|
US$92,446
| |||
· screen every 2 years if >1.0 ng/ml, every 4 years otherwise, 50–74 | 4.0 ng/ml | Dominated | |||
· screen every 2 years if >1.0 ng/ml, every 4 years otherwise, 50–74 | 10.0 ng/ml | US $209,338 | |||
· screen yearly with age dependent threshold, 50–74 | 3.5(50–59), 4.5(60–69), 6.5(70–74) | Dominated | |||
· screen yearly with age dependent threshold 50–74 | 4.5(50–59), 5.5(60–69), 8.5(70–74) | Dominated | |||
· screen every 2 years 55–69 | 3.0 ng/ml | Dominated | |||
· screen every 4 years 55–69 | 3.0 ng/ml | Dominated | |||
· screen every 2 years 55–69 | 10.0 ng/ml | US $170,981 | |||
Selective treatment scenarios | |||||
· screen yearly 45–69 | 4.0 ng/ml | US $163,214 | |||
· screen yearly 50–74 | 4.0 ng/ml | US $243,768 | |||
· screen yearly 55–69 | 4.0 ng/ml |
US $128,680
| |||
· screen yearly if >3.0 ng/ml, every 2 years otherwise,45–69 | 3.0 ng/ml | US $313,214 | |||
· screen every 4 years 50–74 | 4.0 ng/ml |
US $89,333
| |||
· screen every 2 years if >1.0 ng/ml, every 4 years otherwise, 50–74 | 4.0 ng/ml |
US $136,332
| |||
· screen yearly with age dependent threshold, 50–74 | 3.5(50–59), 4.5(60–69), 6.5(70–74) | US $166,784 | |||
· screen yearly with age dependent threshold 50–74 | 4.5(50–59), 5.5(60–69), 8.5(70–74) |
US $124,564
| |||
· screen every 2 years 55–69 | 3.0 ng/ml |
US $120,952
| |||
· screen every 4 years 55–69
|
3.0 ng/ml
|
US $70,831
|
Treatment types
Model features
Model type
Model pathways of prostate cancer
Study | Model-type | Natural history model | By (TNM) stage of cancer? | TNM staging used | Differentiation by Gleason grade? | Gleason grading used | Time horizon | Deterministic sensitivity analysis | Probabilistic sensitivity analysis |
---|---|---|---|---|---|---|---|---|---|
Chilcott et al. [23] | Individual patient simulation | No | Yes | Localised (T1–2), Locally advanced (T3–4) and metastatic | Yes | (G < 7, G = 7, G > 7) | lifetime | Yes | Yes |
Heijnsdijk et al. [25] | Individual patient simulation | Yes -MISCAN | Yes | 18 stages: each tumour stage (T1,2 etc) modelled individually | Yes | (G < 7, G = 7, G > 7) | lifetime | Yes | No |
Hummel and Chilcott [24] | Individual patient simulation and cohort | No | Yes | Localised (T1–2), Locally advanced (T3–4) and metastatic | Yes | (G < 7, G = 7, G > 7) | lifetime | Yes | No |
Keller et al. [29] | Cohort model | No | Yes | Low (≤T1a), intermediate (≤T2b), high risk (>T2b) and metastatic | Yes | G ≤ 6, G ≤ 7, G > 7 | up to 70 years | Yes | Yes |
Kobayashi et al. [27] | Markov cycle tree (cohort) | No | Yes | Localised (T1–2), Locally advanced (T3–4) and metastatic | No | – | up to 80 years old | Yes | No |
Martin et al. [30] | Cohort model | No | No | None | No | – | 50 years (lifetime) | Yes | No |
Pataky et al. [26] | Individual patient simulation | Yes -adapted FHCRC | Yes | Locoregional (≤T2a vs > T2) distant disease | Assumed Yesa | Not reported | assumed lifetime | Yes | No |
Roth et al. [28] | Individual patient simulation | Yes -adapted FHCRC | Yes | Locoregional (≤T2a vs > T2) distant disease | Yesa | Indirectly (8–10/ 2–7) | lifetime | Yes | Yes |
Wolstenholme et al. [31] | Cohort model | No | Yes | Localised (T1–2), Locally advanced (T3–4) and metastatic | No | – | lifetime(100 years old) | Yes | Yes |
Shteynshlyuger & Andriole, [22] | Population based model | – | Yes | No details provided | – | – | lifetime | Yes | No |
Assessing uncertainty in cost-effectiveness results
Model inputs
Quality of life
Study | Study setting | Perspective | Assessment of QoL | Population | Country |
---|---|---|---|---|---|
Chilcott et al. [23] | UK | NHS | HUI/EQ-5D | General population | UK/other |
Heijnsdijk et al. [25] | NR | Healthcare based on included costs | SG/EQ-5D/TTO/VAS | Patients/experts/ general population | Netherlands, US, Canada |
Hummel and Chilcott [24] | UK | NHS | HUI/EQ-5D | General population | UK/other |
Keller et al. [29] | Australia | Healthcare | SF-12/ SF-36/ othera, b | General population | Australia/ Finland |
Kobayashi et al. [27] | NR | Societal | TTO | Physicians/ patients | Unclear |
Martin et al. [30] | Australia | Healthcare | SF-12/ SG | Patient/ General population | US (adjusted)/ Australia |
Pataky et al. [26] | Canada | Healthcare based on included costs | SG | 2 different patient groups | Canada |
Roth et al. [28] | US | US payer perspective | SG | Patient | US |
Study | Starting state | Diagnosis | Treatment | Other | Advanced | End of life | Adverse effects | ||
---|---|---|---|---|---|---|---|---|---|
Biopsy | Cancer | Short- term | Long-term | ||||||
Chilcott, Hummel [23] | Baseline = age dependent | – | – | 0.635 | Bowel function = 0.89 Urinary function = 0.94 Sexual dysfunction =0.9 | ||||
Heijnsdijk et al. [25] | Screening = 0.99 | 0.9 | 0.8 | Radiation = 0.73 | Radiation = 0.78 | Post-recovery = 0.95 | 0.6 | 0.4 | Short-term & long-term effect |
Prostatectomy = 0.67 | Prostatectomy = 0.77 | ||||||||
Active surveillance = 0.97 | Active surveillance = 0.97 | ||||||||
Hummel and Chilcott [24] | Baseline = age dependent | 0.635 | Bowel function = 0.89 Urinary function = 0.94 Sexual dysfunction =0.9 | ||||||
Keller et al. [29] | age dependent/ screening = 1.0 | 0.95b | 0.95b | 0.9 to >0.6b | See treatment: Persistent effects, 3 years post-diagnosis | ||||
Kobayashi et al. [27] | Curable = 0.9 Recurrent = 0.7 | 0.5 | See curable: impotence & incontinence | ||||||
Martin et al. [30] | 0.95a | 0.5 | See cancer | ||||||
Pataky et al. [26] | Healthy screening population = 1.0 | 0.88 | 0.9 | Symptomatic =0.9 | 0.85 | 0.5 | Short-term & long-term effect | ||
Roth et al. [28] | Healthy screening population = 1.0 | 0.75 | 0.92 | Symptomatic =0.89 | 0.75 | 0.33 | Short-term & long-term effect | ||
Surveillance = 0.92 | Surveillance = 0.92 |