Table 2.
Cost-effectiveness results for studies reporting QALYs
| 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 |
Italicised text indicates potentially cost-effective scenario. a Dominated; the strategy is more costly and less effective than the comparator (commonly, usual practice)