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dc.contributor.authorKeller, Andrew
dc.contributor.authorGericke, Christian
dc.contributor.authorWhitty, Jennifer A
dc.contributor.authorYaxley, John
dc.contributor.authorKua, Boon
dc.contributor.authorCoughlin, Geoff
dc.contributor.authorGianduzzo, Troy
dc.date.accessioned2021-07-25T05:44:33Z
dc.date.available2021-07-25T05:44:33Z
dc.date.issued2017
dc.identifier.issn1175-5652
dc.identifier.doi10.1007/s40258-016-0278-6
dc.identifier.urihttp://hdl.handle.net/10072/406289
dc.description.abstractBackground and objectives: The Göteborg randomised population-based prostate cancer screening trial demonstrated that prostate-specific antigen (PSA)-based screening reduces prostate cancer deaths compared with an age-matched control group. Utilising the prostate cancer detection rates from this study, we investigated the clinical and cost effectiveness of a similar PSA-based screening strategy for an Australian population of men aged 50-69 years. Methods: A decision model that incorporated Markov processes was developed from a health system perspective. The base-case scenario compared a population-based screening programme with current opportunistic screening practices. Costs, utility values, treatment patterns and background mortality rates were derived from Australian data. All costs were adjusted to reflect July 2015 Australian dollars (A$). An alternative scenario compared systematic with opportunistic screening but with optimisation of active surveillance (AS) uptake in both groups. A discount rate of 5 % for costs and benefits was utilised. Univariate and probabilistic sensitivity analyses were performed to assess the effect of variable uncertainty on model outcomes. Results: Our model very closely replicated the number of deaths from both prostate cancer and background mortality in the Göteborg study. The incremental cost per quality-adjusted life-year (QALY) for PSA screening was A$147,528. However, for years of life gained (LYGs), PSA-based screening (A$45,890/LYG) appeared more favourable. Our alternative scenario with optimised AS improved cost utility to A$45,881/QALY, with screening becoming cost effective at a 92 % AS uptake rate. Both modelled scenarios were most sensitive to the utility of patients before and after intervention, and the discount rate used. Conclusion: PSA-based screening is not cost effective compared with Australia's assumed willingness-to-pay threshold of A$50,000/QALY. It appears more cost effective if LYGs are used as the relevant outcome, and is more cost effective than the established Australian breast cancer screening programme on this basis. Optimised utilisation of AS increases the cost effectiveness of prostate cancer screening dramatically.
dc.description.peerreviewedYes
dc.languageEnglish
dc.publisherSpringer
dc.relation.ispartofpagefrom95
dc.relation.ispartofpageto111
dc.relation.ispartofissue1
dc.relation.ispartofjournalApplied Health Economics and Health Policy
dc.relation.ispartofvolume15
dc.subject.fieldofresearchHealth services and systems
dc.subject.fieldofresearchPublic health
dc.subject.fieldofresearchApplied economics
dc.subject.fieldofresearchcode4203
dc.subject.fieldofresearchcode4206
dc.subject.fieldofresearchcode3801
dc.subject.keywordsSocial Sciences
dc.subject.keywordsScience & Technology
dc.subject.keywordsLife Sciences & Biomedicine
dc.subject.keywordsEconomics
dc.subject.keywordsHealth Care Sciences & Services
dc.titleA cost-utility analysis of prostate cancer screening in Australia
dc.typeJournal article
dc.type.descriptionC1 - Articles
dcterms.bibliographicCitationKeller, A; Gericke, C; Whitty, JA; Yaxley, J; Kua, B; Coughlin, G; Gianduzzo, T, A cost-utility analysis of prostate cancer screening in Australia, Applied Health Economics and Health Policy, 2017, 15 (1), pp. 95-111
dc.date.updated2021-07-25T05:40:41Z
gro.rights.copyright© 2017 Springer. This is an electronic version of an article published in Applied Health Economics and Health Policy, 2017, 15 (1), pp. 95-111. Applied Health Economics and Health Policy is available online at: http://link.springer.com/ with the open URL of your article.
gro.hasfulltextFull Text
gro.griffith.authorWhitty, Jennifer A.


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