{"doi":"10.1007/s40273-022-01191-1","title":"Cost-Effectiveness Analysis of Prostate Cancer Screening in the UK: A Decision Model Analysis Based on the CAP Trial","abstract":"BACKGROUND AND OBJECTIVE: Most guidelines in the UK, Europe and North America do not recommend organised population-wide screening for prostate cancer. Prostate-specific antigen-based screening can reduce prostate cancer-specific mortality, but there are concerns about overdiagnosis, overtreatment and economic value. The aim was therefore to assess the cost effectiveness of eight potential screening strategies in the UK. METHODS: We used a cost-utility analysis with an individual-based simulation model. The model was calibrated to data from the 10-year follow-up of the Cluster Randomised Trial of PSA Testing for Prostate Cancer (CAP). Treatment effects were modelled using data from the Prostate Testing for Cancer and Treatment (ProtecT) trial. The participants were a hypothetical population of 10 million men in the UK followed from age 30 years to death. The strategies were: no screening; five age-based screening strategies; adaptive screening, where men with an initial prostate-specific antigen level of < 1.5 ng/mL are screened every 6 years and those above this level are screened every 4 years; and two polygenic risk-stratified screening strategies. We assumed the use of pre-biopsy multi-parametric magnetic resonance imaging for men with prostate-specific antigen ≥ 3 ng/mL and combined transrectal ultrasound-guided and targeted biopsies. The main outcome measures were projected lifetime costs and quality-adjusted life-years from a National Health Service perspective. RESULTS: All screening strategies increased costs compared with no screening, with the majority also increasing quality-adjusted life-years. At willingness-to-pay thresholds of £20,000 or £30,000 per quality-adjusted life-year gained, a once-off screening at age 50 years was optimal, although this was sensitive to the utility estimates used. Although the polygenic risk-stratified screening strategies were not on the cost-effectiveness frontier, there was evidence to suggest that they were less cost ineffective than the alternative age-based strategies. CONCLUSIONS: Of the prostate-specific antigen-based strategies compared, only a once-off screening at age 50 years was potentially cost effective at current UK willingness-to-pay thresholds. An additional follow-up of CAP to 15 years may reduce uncertainty about the cost effectiveness of the screening strategies.","journal":"PharmacoEconomics","year":2022,"id":256864,"datarank":0.4493598410330987,"base_score":2.995732273553991,"endowment":2.995732273553991,"self_citation_contribution":0.4493598410330987,"citation_network_contribution":0.0,"self_endowment_contribution":0.4493598410330987,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":19,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9488,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":906207,"name":"Sabina Sanghera","orcid":"0000-0001-8387-3103","position":1,"is_corresponding":false},{"id":78830,"name":"Richard M Martin","orcid":"0000-0002-7992-7719","position":2,"is_corresponding":false},{"id":407350,"name":"Roman Gulati","orcid":"0000-0002-7592-6567","position":3,"is_corresponding":false},{"id":240077,"name":"Fredrik Wiklund","orcid":"0000-0002-4623-0544","position":4,"is_corresponding":false},{"id":467899,"name":"Eleanor Walsh","orcid":"0000-0001-7696-3661","position":5,"is_corresponding":false},{"id":240088,"name":"Jenny Donovan","orcid":"0000-0002-6488-5472","position":6,"is_corresponding":false},{"id":13525,"name":"Freddie C. Hamdy","orcid":"0000-0003-2627-2154","position":7,"is_corresponding":false},{"id":13856,"name":"David E. Neal","orcid":"0000-0002-6033-5086","position":8,"is_corresponding":false},{"id":707839,"name":"J. Athene Lane","orcid":"0000-0002-7578-4925","position":9,"is_corresponding":false},{"id":467900,"name":"Emma L. Turner","orcid":"0000-0003-2575-387X","position":10,"is_corresponding":false},{"id":308323,"name":"Howard Thom","orcid":"0000-0001-8576-5552","position":11,"is_corresponding":false},{"id":906208,"name":"Mark Clements","orcid":"0000-0003-4518-5670","position":12,"is_corresponding":false},{"id":906206,"name":"Edna Keeney","orcid":"0000-0002-4763-8891","position":0,"is_corresponding":true}],"reference_count":51,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T00:25:25.728895Z","pmid":"36201131","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}