TY - JOUR
T1 - Cost implications of PSA screening differ by age
AU - Rao, Karthik
AU - Liang, Stella
AU - Cardamone, Michael
AU - Joshu, Corinne E.
AU - Marmen, Kyle
AU - Bhavsar, Nrupen
AU - Nelson, William G.
AU - Ballentine Carter, H.
AU - Albert, Michael C.
AU - Platz, Elizabeth A.
AU - Pollack, Craig E.
N1 - Funding Information:
Dr. Rao’s effort was supported by the Johns Hopkins Dean’s Research Fellowship. Dr. Pollack’s salary is supported by the National Cancer Institute and Office of Behavioral and Social Sciences (K07 CA151910). Cancer Center Support Grant (P30 CA006973, Nelson WG). Pilot funding was from the Johns Hopkins Individualized Health Initiative (Platz EA).
Publisher Copyright:
© 2018 The Author(s).
PY - 2018/5/9
Y1 - 2018/5/9
N2 - Background: Multiple guidelines seek to alter rates of prostate-specific antigen (PSA)-based prostate cancer screening. The costs borne by payers associated with PSA-based screening for men of different age groups - including the costs of screening and subsequent diagnosis, treatment, and adverse events - remain uncertain. We sought to develop a model of PSA costs that could be used by payers and health care systems to inform cost considerations under a range of different scenarios. Methods: We determined the prevalence of PSA screening among men aged 50 and higher using 2013-2014 data from a large, multispecialty group, obtained reimbursed costs associated with screening, diagnosis, and treatment from a commercial health plan, and identified transition probabilities for biopsy, diagnosis, treatment, and complications from the literature to generate a cost model. We estimated annual total costs for groups of men ages 50-54, 55-69, and 70+ years, and varied annual prostate cancer screening prevalence in each group from 5 to 50% and tested hypothetical examples of different test characteristics (e.g., true/false positive rate). Results: Under the baseline screening patterns, costs of the PSA screening represented 10.1% of the total costs; costs of biopsies and associated complications were 23.3% of total costs; and, although only 0.3% of all screen eligible patients were treated, they accounted for 66.7% of total costs. For each 5-percentage point decrease in PSA screening among men aged 70 and older for a single calendar year, total costs associated with prostate cancer screening decreased by 13.8%. For each 5-percentage point decrease in PSA screening among men 50-54 and 55-69 years old, costs were 2.3% and 7.3% lower respectively. Conclusions: With constrained financial resources and with national pressure to decrease use of clinically unnecessary PSA-based prostate cancer screening, there is an opportunity for cost savings, especially by focusing on the downstream costs disproportionately associated with screening men 70 and older.
AB - Background: Multiple guidelines seek to alter rates of prostate-specific antigen (PSA)-based prostate cancer screening. The costs borne by payers associated with PSA-based screening for men of different age groups - including the costs of screening and subsequent diagnosis, treatment, and adverse events - remain uncertain. We sought to develop a model of PSA costs that could be used by payers and health care systems to inform cost considerations under a range of different scenarios. Methods: We determined the prevalence of PSA screening among men aged 50 and higher using 2013-2014 data from a large, multispecialty group, obtained reimbursed costs associated with screening, diagnosis, and treatment from a commercial health plan, and identified transition probabilities for biopsy, diagnosis, treatment, and complications from the literature to generate a cost model. We estimated annual total costs for groups of men ages 50-54, 55-69, and 70+ years, and varied annual prostate cancer screening prevalence in each group from 5 to 50% and tested hypothetical examples of different test characteristics (e.g., true/false positive rate). Results: Under the baseline screening patterns, costs of the PSA screening represented 10.1% of the total costs; costs of biopsies and associated complications were 23.3% of total costs; and, although only 0.3% of all screen eligible patients were treated, they accounted for 66.7% of total costs. For each 5-percentage point decrease in PSA screening among men aged 70 and older for a single calendar year, total costs associated with prostate cancer screening decreased by 13.8%. For each 5-percentage point decrease in PSA screening among men 50-54 and 55-69 years old, costs were 2.3% and 7.3% lower respectively. Conclusions: With constrained financial resources and with national pressure to decrease use of clinically unnecessary PSA-based prostate cancer screening, there is an opportunity for cost savings, especially by focusing on the downstream costs disproportionately associated with screening men 70 and older.
KW - Costs
KW - Prostate cancer
KW - Screening
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U2 - 10.1186/s12894-018-0344-5
DO - 10.1186/s12894-018-0344-5
M3 - Article
C2 - 29743049
AN - SCOPUS:85046663729
VL - 18
JO - BMC Urology
JF - BMC Urology
SN - 1471-2490
IS - 1
M1 - 38
ER -