Abstract
Background
Screening men for prostate cancer using prostate-specific antigen (PSA) testing remains controversial. We aimed to estimate the likely budgetary impact on secondary care in England and Wales to inform screening decision makers.
Methods
The Cluster randomised triAl of PSA testing for Prostate cancer study (CAP) compared a single invitation to men aged 50–69 for a PSA test with usual care (no screening). Routinely collected hospital care data were obtained for all men in CAP, and NHS reference costs were mapped to each event via Healthcare Resource Group (HRG) codes. Secondary-care costs per man per year were calculated, and cost differences (and population-level estimates) between arms were derived annually for the first five years following randomisation.
Results
In the first year post-randomisation, secondary-care costs averaged across all men (irrespective of a prostate cancer diagnosis) in the intervention arm (n = 189279) were £44.80 (95% confidence interval: £18.30-£71.30) higher than for men in the control arm (n = 219357). Extrapolated to a population level, the introduction of a single PSA screening invitation could lead to additional secondary care costs of £314 million.
Conclusions
Introducing a single PSA screening test for men aged 50–69 across England and Wales could lead to very high initial secondary-care costs.
Screening men for prostate cancer using prostate-specific antigen (PSA) testing remains controversial. We aimed to estimate the likely budgetary impact on secondary care in England and Wales to inform screening decision makers.
Methods
The Cluster randomised triAl of PSA testing for Prostate cancer study (CAP) compared a single invitation to men aged 50–69 for a PSA test with usual care (no screening). Routinely collected hospital care data were obtained for all men in CAP, and NHS reference costs were mapped to each event via Healthcare Resource Group (HRG) codes. Secondary-care costs per man per year were calculated, and cost differences (and population-level estimates) between arms were derived annually for the first five years following randomisation.
Results
In the first year post-randomisation, secondary-care costs averaged across all men (irrespective of a prostate cancer diagnosis) in the intervention arm (n = 189279) were £44.80 (95% confidence interval: £18.30-£71.30) higher than for men in the control arm (n = 219357). Extrapolated to a population level, the introduction of a single PSA screening invitation could lead to additional secondary care costs of £314 million.
Conclusions
Introducing a single PSA screening test for men aged 50–69 across England and Wales could lead to very high initial secondary-care costs.
| Original language | English |
|---|---|
| Article number | 610 |
| Journal | BMC Health Services Research |
| Volume | 23 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 9 Jun 2023 |
Bibliographical note
Funding Information:The CAP trial is funded by Cancer Research UK/UK Department of Health (C11043/A4286, C18281/A8145, C18281/A11326, C18281/A15064 and C18281/A24432). The ProtecT trial is funded by the UK National Institute for Health Research (NIHR) Health Technology Assessment Programme (projects 96/20/06, 96/20/99) with the University of Oxford (Oxford, UK) as sponsor. RMM was supported by a Cancer Research UK (C18281/A29019) programme grant (the Integrative Cancer Epidemiology Programme). All authors had financial support from Cancer Research UK and the UK Department of Health. RMM was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. RMM, FCH, DEN and JLD are NIHR Senior Investigators. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The authors declare no financial relationships with any organisations that might have an interest in the submitted work in the previous three years and no other relationships or activities that could appear to have influenced the submitted work. External research grants administered by the Universities are listed above.
Funding Information:
The authors acknowledge the contribution of the CAP trial group. Investigators: RMM (Lead PI), JLD (PI), DEN (PI), FCH (PI), ET (Trial Co-ordinator), Chris Metcalfe (Statistician), Jonathan Sterne (Statistician), SMN (Health Economist). Research staff: Liz Hill, Siaw Yein Ng, Naomi Williams, Liz Down (data manager), EW (data manager), JCT (health economist), Charlotte Davies, Laura Hughes, Mari-Anne Rowlands, Lindsey Bell, Sean Harrison, Jess Toole. Administrative staff: Marta Tazewell, Genevieve Hatton-Brown, Chris Pawsey. Management committee: ELT (chair), RMM, JLD, Chris Metcalfe, Jonathan Sterne, SN, Yoav Ben-Shlomo, Athene Lane, Steven Oliver, Peter Brindle, Simon Evans. Trial steering committee: Michael Baum (chair), Peter Albertsen, Tracy Roberts, Mary Robinson, Jan Adolfsson, David Dearnaley, Anthony Zeitman, Fritz Schröder, Tim Peters, Peter Holding, Teresa Lennon, Sue Bonnington, Malcolm Mason, Jon Oxley, RMM, JLD, DEN, FCH, ELT, Athene Lane. Data monitoring committee: Lars Holmberg (chair), Robert Pickard, Simon Thompson, Usha Menon. Cause of death committee: Peter Albertsen (chair), Colette Reid, Jon McFarlane, Jon Oxley, Mary Robinson, Jan Adolfsson, Michael Baum, Anthony Zeitman, Amit Bahl, Anthony Koupparis. We thank Athene Lane for helpful comments on the manuscript. This study makes use of anonymised data held in the Secure Anonymised Information Linkage (SAIL) Databank. We would like to acknowledge all the data providers who make anonymised data available for research and, for this research in particular, NHS Digital, the Office for National Statistics, Public Health Wales and Public Health England. Responsibility for the interpretation of the data provided by SAIL lies with the authors alone.
Publisher Copyright:
© 2023, The Author(s).
Research Groups and Themes
- HEHP@Bristol
