Economic Evaluation Of Percent Free Psa For Prostate Cancer Detection In Taiwanese Men.

Abstract

The prevalence of prostate cancer in the Chinese population with abnormal prostate-specific antigen (PSA) levels of 4.0-10.0 ng/ml is low. The diagnosis can only rely on transrectal ultrasound-guided prostate biopsies (TRUS-Bx) which may cause major complications. We assess the cost-effectiveness of two diagnostic strategies for prostate cancer detection in Chinese men with abnormal PSA levels of 4.0-10.0 ng/ml and normal digital rectal examination of prostate (DRE). Using a decision tree model, we performed a cost-effectiveness analysis to compare the two strategies: 1) direct prostate biopsies (TRUS-Bx) and 2) percent free PSA testing prior to TRUS-Bx. A systematic review of 855 patients with PSA levels of 4.0-10.0 ng/ml and normal DRE enrolled in a single medical institute from Jan 2002 to December 2005 was conducted. The outcome measures were the incremental cost-effectiveness ratio, and costs were calculated through activity-accumulation costing based on National Insurance Scheme Bill Size. A one-way sensitivity analysis was undertaken. The effectiveness was measured by means of the number of detected cases and actual cases (detected cases minus lost cases). A threshold analysis is used to illustrate the value of a given variable of which the two strategies have equal outcomes or costs. The strategy of percent free PSA with TRUS-Bx was dominant and found to be the most cost-effective. The incremental cost-effectiveness ratio for free PSA + TRUS-Bx compared with TRUS-Bx was USD 3,871.58. Strategy 2 (TRUS-Bx) would be more cost-effective if the cost of percent free PSA increased to USD 36.78 or if prostate cancer prevalence increased to 42%. The use of percent free PSA prior to TRUS-Bx is the most cost-effective diagnostic strategy and will become more cost-effective as prostate cancer prevalence increases in the ageing population and the free PSA test costs down