A cost-benefit analysis of mass prostate cancer screening

Hiro Farabi; Najmeh Moradi; Aziz Ahmadzadeh; Seyed Mohammad Kazem Aghamir; Abdolreza Mohammadi; Aziz Rezapour

doi:10.1186/s12962-024-00553-0

A cost-benefit analysis of mass prostate cancer screening

Cost Eff Resour Alloc. 2024 May 5;22(1):37. doi: 10.1186/s12962-024-00553-0.

Authors

Hiro Farabi¹, Najmeh Moradi², Aziz Ahmadzadeh³, Seyed Mohammad Kazem Aghamir⁴, Abdolreza Mohammadi⁴, Aziz Rezapour⁵

Affiliations

¹ Barts and the London Pragmatic Clinical Trials Unit, Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, UK. h.farabi@qmul.ac.uk.
² Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
³ Insurance Research Center (IRC), Tehran, Iran.
⁴ Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
⁵ Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

Abstract

Background: Prostate cancer (PCa) causes a substantial health and financial burden worldwide, underscoring the need for efficient mass screening approaches. This study attempts to evaluate the Net Cost-Benefit Index (NCBI) of PCa screening in Iran to offer insights for informed decision-making and resource allocation.

Method: The Net Cost-Benefit Index (NCBI) was calculated for four age groups (40 years and above) using a decision-analysis model. Two screening strategies, prostate-specific antigen (PSA) solely and PSA with Digital Rectal Examination (DRE), were evaluated from the health system perspective. A retrospective assessment of 1402 prostate cancer (PCa) patients' profiles were conducted, and direct medical and non-medical costs were calculated based on the 2021 official tariff rates, patient records, and interviews. The monetary value of mass screening was determined through Willingness to Pay (WTP) assessments, which served as a measure for the benefit aspect.

Result: The combined PSA and DRE strategy of screening is cost-effective, yields up to $3 saving in costs per case and emerges as the dominant strategy over PSA alone. Screening for men aged 70 and above does not meet economic justification, indicated by a negative Net Cost-Benefit Index (NCBI). The 40-49 age group exhibits the highest net benefit, $13.81 based on basic information and $13.54 based on comprehensive information. Sensitivity analysis strongly supports the cost-effectiveness of the combined screening approach.

Conclusion: This study advocates prostate cancer screening with PSA and DRE, is economically justified for men aged 40-69. The results of the study recommend that policymakers prioritize resource allocation for PCa screening programs based on age and budget constraints. Men's willingness to pay, especially for the 40-49 age group which had the highest net benefit, leverages their financial participation in screening services. Additionally, screening services for other age groups, such as 50-54 or 55-59, can be provided either for free or at a reduced cost.

Keywords: Cost-benefit analysis; Decision model; Health decision-making.; Prostate cancer; Screening; Willingness to pay.