Cost-Effectiveness Analysis of Prostate Cancer Screening in Brazil

Renato Almeida Rosa de Oliveira; Thiago Camelo Mourão; Thiago Borges Marques Santana; Ricardo de Lima Favaretto; Stenio de Cassio Zequi; Gustavo Cardoso Guimarães

doi:10.1016/j.vhri.2021.02.002

Cost-Effectiveness Analysis of Prostate Cancer Screening in Brazil

Value Health Reg Issues. 2021 Dec:26:89-97. doi: 10.1016/j.vhri.2021.02.002. Epub 2021 Jun 16.

Authors

Renato Almeida Rosa de Oliveira¹, Thiago Camelo Mourão², Thiago Borges Marques Santana², Ricardo de Lima Favaretto², Stenio de Cassio Zequi³, Gustavo Cardoso Guimarães⁴

Affiliations

¹ Urology Department, Beneficência Portuguesa de São Paulo, São Paulo, Brazil; Instituto de Urologia, Oncologia e Cirurgia Robótica, São Paulo, Brazil. Electronic address: oliveira.rar@hotmail.com.
² Urology Department, Beneficência Portuguesa de São Paulo, São Paulo, Brazil; Instituto de Urologia, Oncologia e Cirurgia Robótica, São Paulo, Brazil.
³ Urology Department, AC Camargo Cancer Center - São Paulo, São Paulo, Brazil.
⁴ Instituto de Urologia, Oncologia e Cirurgia Robótica, São Paulo, Brazil; Surgical Oncology Department, Beneficência Portuguesa de São Paulo, São Paulo, Brazil.

PMID: 34146776
DOI: 10.1016/j.vhri.2021.02.002

Abstract

Introduction: Prostate cancer is one of the most common malignancies among men worldwide. Prostate-specific antigen (PSA) screening shows uncertain benefits and harms from clinical and economic perspectives, resulting in an important impact on healthcare systems. Because of nonstandardized studies and substantial differences among populations, data are still inconclusive.

Objective: The objective of this study was to carry out long-term cost-effectiveness and cost-utility analysis on the PSA-screened population from the service provider's perspective in the Brazilian population.

Methods: We performed a cost-effectiveness and cost-utility analysis using clinical outcomes obtained from 9692 men enrolled in the PSA screening program. Prostate cancer treatments, 5-year follow-up outcomes, and all related costs were examined. Data were compared with a nonscreened prostate cancer population to calculate incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR). ICER and ICUR were compared with the Brazilian-established willingness-to-pay (WTP) threshold (WTP = R$ 114 026.55).

Results: A total of 251 of 9692 men had a diagnosis of prostate cancer (2.6%), of which 90% had localized disease. Two hundred and five patients were treated as follows: surgery (45.37%); radiation therapy (11.22%); radiation plus androgen deprivation therapy (21.95%); active surveillance (13.17%); exclusive androgen deprivation therapy (7.32%); and watchful waiting (0.98%). Two simulated cohorts were compared based on screening and nonscreening groups. Values obtained were-ICER of R$ 44 491.39 per life saved and ICUR of R$ 10 851.56 per quality-adjusted life year (QALY) gained-below the Brazilian WTP threshold and showed cost-effectiveness and cost-utility advantages.

Conclusion: According to the Brazilian WTP, PSA screening is a cost-effective policy from a hospital and long-term perspective and should have more standardized studies developed in different populations and economies.

Keywords: cost effectiveness; prostate cancer; quality-adjusted life year (QALY); screening.

MeSH terms

Androgen Antagonists
Brazil
Cost-Benefit Analysis
Early Detection of Cancer
Humans
Male
Prostate-Specific Antigen*
Prostatic Neoplasms* / diagnosis

Substances

Androgen Antagonists
Prostate-Specific Antigen