Cost‐effectiveness of Prostate Health Index for prostate cancer detection

• Published in: BJU international 2012-08, Vol.110 (3), p.353-362
• Main Authors: Nichol, Michael B., Wu, Joanne, Huang, Joice, Denham, Dwight, Frencher, Stanley K., Jacobsen, Steven J.
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Cost-Benefit Analysis; cost‐effectiveness analysis; Early Detection of Cancer - economics; Early Detection of Cancer - methods; free PSA; Gynecology. Andrology. Obstetrics; Health care expenditures; Humans; Male; Male genital diseases; Markov Chains; Medical sciences; Medical screening; Men; Mens health; Middle Aged; Nephrology. Urinary tract diseases; Prostate cancer; prostate health index (phi); Prostate-Specific Antigen - blood; Prostate-Specific Antigen - economics; prostate‐specific antigen (PSA); Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - economics; PSA precursor form [−2]proPSA; Quality-Adjusted Life Years; Reference Values; Sensitivity analysis; Sensitivity and Specificity; Severity of Illness Index; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2011.10751.x

Study Type – Diagnostic (cost effectiveness) Level of Evidence 2b What's known on the subject? and What does the study add? The Beckman Coulter prostate health index (phi) was developed as a combination of serum prostate specific antigen (PSA), free PSA and a PSA precursor form [−2]proPSA to calculate the probability of prostate cancer and was used as an aid in distinguishing prostate cancer from benign prostatic conditions for men with PSA test 2–10 ng/mL and non‐suspicious digital rectal examination. Phi has been shown to improve diagnostic accuracy in prostate cancer detection compared with total and free PSA. An earlier 1‐year budget impact analysis revealed it to be a complementary approach to current prostate cancer screening strategies. The current study evaluated the cost‐effectiveness of early prostate cancer detection with phi in combination with a PSA test compared with a PSA test alone from the US societal perspective. The model with over 25 annual screening cycles for men aged 50–75 years indicated that PSA plus phi dominated the PSA test alone in prostate cancer detection and consequent treatment. PSA plus phi may be an important strategy for prostate cancer detection. OBJECTIVE •  To evaluate the cost‐effectiveness of early prostate cancer detection with the Beckman Coulter Prostate Health Index (phi) (not currently available in the USA) adding to the serum prostate‐specific antigen (PSA) test compared with the PSA test alone from the US societal perspective. PATIENTS AND METHODS •  Phi was developed as a combination of PSA, free PSA, and a PSA precursor form [−2]proPSA to calculate the probability of prostate cancer and was used as an aid in distinguishing prostate cancer from benign prostatic conditions for men with a borderline PSA test (e.g. PSA 2–10 ng/mL or 4–10 ng/mL) and non‐suspicious digital rectal examination. •  We constructed a Markov model with probabilistic sensitivity analysis to estimate expected costs and utilities of prostate cancer detection and consequent treatment for the annual prostate cancer screening in the male population aged 50–75 years old. •  The transition probabilities, health state utilities and prostate cancer treatment costs were derived from the published literature. The diagnostic performance of phi was obtained from a multi‐centre study. Diagnostic related costs were obtained from the 2009 Medicare Fee Schedule. •  Cost‐effectiveness was compared between the strategies of PSA test alone and PSA plus phi