Abstract
BackgroundIncidence and prevalence of prostate cancer in Sweden have increased markedly due to prostate-specific antigen (PSA) testing. Moreover, new diagnostic tests and treatment technologies are expected to further increase the overall costs. Our aims were (i) to estimate the societal costs for existing testing, diagnosis, management and treatment of prostate cancer, and (ii) to provide reference values for future cost-effectiveness analyses of prostate cancer screening and treatment.MethodsTaking a societal perspective, this study aimed to investigate the annual cost of prostate cancer in Sweden using a prevalence-based cost-of-illness approach. Resource utilisation and related costs within Stockholm Region during 2016 were quantified using data from the Stockholm PSA and Biopsy Register and other health and population registers. Costs included: (i) direct medical costs for health care utilisation at primary care, hospitals, palliative care and prescribed drugs; (ii) informal care; and (iii) indirect costs due to morbidity and premature mortality. The resource utilisation was valued using unit costs for direct medical costs and the human capital method for informal care and indirect costs. Costs for the Stockholm region were extrapolated to Sweden based on cancer prevalence and the average costs by age and resource type.ResultsThe societal costs due to prostate cancer in Stockholm in 2016 were estimated to be €64 million Euro (€Mn), of which the direct medical costs, informal care and productivity losses represented 62, 28 and 10% of the total costs, respectively. The total annual costs extrapolated to Sweden were calculated to be €281 Mn. The average direct medical cost, average costs for informal care and productivity losses per prevalent case were €1510, €828 and €271, respectively. These estimates were sensitive to assumptions related to the proportion of primary care visits associated with PSA testing and the valuation method for informal care.ConclusionThe societal costs due to prostate cancer were substantial and constitute a considerable burden to Swedish society. Data from this study are relevant for future cost-effectiveness evaluations of prostate cancer screening and treatment.
Highlights
Incidence and prevalence of prostate cancer in Sweden have increased markedly due to prostatespecific antigen (PSA) testing
Direct medical costs Inpatient and outpatient care Ten prostate cancer (PCa)-related Diagnosis-Related Group (DRG) were identified for 1602 patients from inpatient care (Table 2); 45.8% of those patients were aged 70–79 years
We identified 4841 patients with resource utilisation in outpatient care from eight DRGs (Table 2)
Summary
Incidence and prevalence of prostate cancer in Sweden have increased markedly due to prostatespecific antigen (PSA) testing. New diagnostic tests and treatment technologies are expected to further increase the overall costs. The European Randomized Study of Screening for PCa found a mortality reduction of 20% after 16-year follow-up from PSA testing compared with no testing [7]. PSA testing is associated with potential harms, including unnecessary biopsies, over-diagnosis of low-risk cancers and over-treatment [4, 5]. Unnecessary biopsies and over-diagnosis may reduce health-related quality of life of the patients, but they are associated with increased costs due to increased health-care visits, biopsy-related complications, over-treatment and lost productivity [4]
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