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Cost effectiveness analysis of prostate cancer screening strategies in Germany: a microsimulation study : cancer therapy and prevention

Prostate cancer (PCa) represents a significant public health challenge in Germany, with increasing incidence and economic impact. This study assessed the cost-effectiveness of 10 screening strategies: prostate-specific antigen-based risk-adaptive screening (PSA-RAS), with or without magnetic resonan...

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Hauptverfasser: Muchadeyi, Muchandifunga Trust (VerfasserIn) , Hao, Shuang (VerfasserIn) , Hernandez-Villafuerte, Karla (VerfasserIn) , Khan, Shah Alam (VerfasserIn) , Becker, Nikolaus (VerfasserIn) , Krilaviciute, Agne (VerfasserIn) , Seibold, Petra (VerfasserIn) , Gulati, Roman (VerfasserIn) , Albers, Peter (VerfasserIn) , Schlander, Michael (VerfasserIn) , Clements, Mark (VerfasserIn)
Dokumenttyp: Article (Journal)
Sprache:Englisch
Veröffentlicht: 15 October 2025
In: International journal of cancer
Year: 2025, Jahrgang: 157, Heft: 8, Pages: 1662-1679
ISSN:1097-0215
DOI:10.1002/ijc.35513
Online-Zugang:Verlag, kostenfrei, Volltext: https://doi.org/10.1002/ijc.35513
Verlag, kostenfrei, Volltext: http://onlinelibrary.wiley.com/doi/abs/10.1002/ijc.35513
Volltext
Verfasserangaben:Muchandifunga Trust Muchadeyi, Shuang Hao, Karla Hernandez-Villafuerte, Shah Alam Khan, Nikolaus Becker, Agne Krilaviciute, Petra Seibold, Roman Gulati, Peter Albers, Michael Schlander, Mark Clements
Beschreibung
Zusammenfassung:Prostate cancer (PCa) represents a significant public health challenge in Germany, with increasing incidence and economic impact. This study assessed the cost-effectiveness of 10 screening strategies: prostate-specific antigen-based risk-adaptive screening (PSA-RAS), with or without magnetic resonance imaging (MRI), in men starting at age 45 or 50 and stopping at 60 or 70, digital rectal examination (DRE) for ages 45-75 years, and no screening. Using a well calibrated microsimulation model (Swedish Prostata) from a statutory health insurance perspective, lifetime outcomes were evaluated, including cancer incidence, mortality, overdiagnosis, biopsies, life-years, and quality-adjusted life-years (QALYs) discounted annually at 3%. Cost and utility inputs were derived from the German diagnostic-related group schedule, fee-for-service catalogues, literature, and expert opinion. DRE-only was the least cost-effective, yielding high biopsy and overdiagnosis rates with minimal QALY gains. PSA-RAS reduced overdiagnosis and biopsy rates, with PSA-RAS (50-60 years) without MRI emerging as the most cost-efficient strategy, saving approximately €1.2 million per 100,000 men compared with no screening. Extending the PSA-RAS to 70 years improved its effectiveness in terms of QALYs. PSA-RAS (50-70) with MRI could become cost-effective at an increasing willingness to pay threshold or decreasing MRI cost. This study suggests the potential of PSA-RAS to improve PCa screening in Germany. Incorporating MRI, reducing MRI cost within the screening setting, and extending screening to 70 to align with EU recommendations could improve the cost-effectiveness of PSA-RAS with MRI. Future research should explore the integration of MRI with ancillary tests, such as 4K-score or risk calculators, to reduce MRI use and associated costs.
Beschreibung:Erstmals veröffentlicht: 16. Juli 2025
Gesehen am 15.09.2025
Beschreibung:Online Resource
ISSN:1097-0215
DOI:10.1002/ijc.35513

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