Systematic Review on the Cost Effectiveness of Prostate Cancer Screening in Europe

Abstract

Background and objective: In Europe, prostate cancer (PCa) is the most common cancer in men. Screening may therefore be crucial to lower health care costs, morbidity, and mortality. This systematic review aimed to provide a contemporary overview of the costs and benefits of PCa screening programmes.

Methods: A peer-reviewed literature search was conducted, using the PICO method. A detailed search strategy was developed in four databases based on the following key search terms: "PCa", "screening", and "cost effectiveness". Any type of economic evaluation was included. The search strategy was restricted to European countries, but no restrictions were set on the year of publication.

Key findings and limitations: A total of 7484 studies were identified initially. Of these, 19 studies described the cost effectiveness of PCa screening in Europe. Among the studies using an initially healthy study population, most focussed on risk- and/or age- and/or magnetic resonance imaging (MRI)-based screening in addition to prostate-specific antigen (PSA) testing and compared this with no screening. Incremental cost ratios (ICERs) varied from €5872 per quality-adjusted life year (QALY) to €372 948/QALY, with a median of €56 487/QALY. Risk-based screening followed by MRI testing seemed to be a more cost-effective strategy than no screening.

Conclusions and clinical implications: This systematic review indicates that screening programmes incorporating a risk-based approach and MRI have the potential to be cost effective.

Patient summary: In this review, we looked at the cost effectiveness of prostate cancer screening in Europe. We found that a risk-based approach and incorporation of magnetic resonance imaging has the potential to be cost effective. However, there remains a knowledge gap regarding cost effectiveness of prostate cancer screening. Therefore, determinants of cost effectiveness require further investigation.

Keywords: Cost effectiveness; PRostate cancer Awareness and Initiative for Screening in the European Union; Prostate cancer; Screening.

Fig. 1

PRISMA flow chart of included studies. PRISMA = Preferred Reporting Items for Systematic reviews and Meta-analyses.

Fig. 2

ICERs according to screening strategies initially in health participants (PCa screening strategies compared with no screening): age-based screening (black), risk-based screening (green), and MRI/biopsy screening (red). ICER = incremental cost ratio; MRI = magnetic resonance imaging; PCa = prostate cancer; QALY = quality-adjusted life year S = societal perspective , , , ; SBx = systematic biopsy; TBx = targeted biopsy. *Hao and colleagues ; MRI + TBx (ICER: €83 789/QALY), MRI + TBx (ICER: €88 054 /QALY), SBx (ICER: €102 510/QALY), and MRI-SBx + TBx/SBx (ICER: €133 558/QALY). °Keeney and colleagues ; risk stratified 2 yearly to age 70 yr (€937 848/QALY gained).