Abstract
Callender et al. recently published a model-based cost-effectiveness analysis of a risk-tailored approach to prostate cancer screening. It considers the costs and effects of prostate cancer screening offered to all men aged 55-69 without any risk selection and, alternatively, over a range of risk-tailored strategies in which screen eligibility is determined by a varying threshold of disease risk. The analysis finds that the strategy of screening men once they reach a 10-year absolute risk of disease of 5% or more is cost-effective in a UK context. I believe there are several problems with the study, mostly stemming from an incorrect interpretation of the cost-effectiveness estimates. I show that one reinterpretation of their results indicates that screening is much less cost-effective than the original analysis suggests, indicating that screening should be restricted to a much smaller group of higher risk men. More broadly, I explain the challenges of attempting to meaningfully reinterpret the originally published results due to the simulation of non-mutually exclusive intervention strategies. Finally, I consider the relevance of considering sufficient alternative screening intensities. This critique highlights the need for appropriate interpretation of cost-effectiveness results for policymakers, especially as risk stratification within screening becomes increasingly feasible.
Highlights
Callender et al.[1] recently published a cost-effectiveness analysis (CEA) of a risk-tailored approach to prostate cancer screening
Callender et al.’s1 analysis estimates the total net costs and quality-adjusted life-years (QALYs) of alternative screening approaches. They examine prostate-specific antigen (PSA) based testing every four years between ages 55–69. They consider this strategy when applied to all men within that age range and alternatively, the same strategy starting only when men meet a range of alternative prostate cancer risk thresholds
They consider 17 alternative risk thresholds ranging from 2% to 10% 10-year absolute risk (10y-AR) in 0.5% increments
Summary
1. Paul Carty , Health Information and Quality Authority, Dublin, Ireland Conor Teljeur , Health Information and Quality Authority, Dublin, Ireland. 2. Eveline Heijnsdijk, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. 3. Robert Boer , Allergan plc., Irvine, USA Any reports and responses or comments on the article can be found at the end of the article. Author roles: O'Mahony JF: Conceptualization, Formal Analysis, Investigation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing. Grant information: Health Research Board Ireland [EIA-2017-054]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. How to cite this article: O'Mahony JF.
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