Cost-effectiveness of PSA testing for the secondary prevention of prostate cancer

The aim of this project is to estimate the cost-effectiveness of Prostate Specific Antigen (PSA) testing for the secondary prevention of prostate cancer. Prostate cancer is the most commonly diagnosed cancer in men in Ireland. Incidence rates have been rising faster than those for any other cancer, largely as a result of widespread PSA testing.  Although there is no organised PSA testing in place in Ireland, and the value of PSA testing as a prostate cancer screening tool is uncertain, rates of testing are very high. 

The costs of unregulated PSA testing in Ireland (and elsewhere) are not well understood, but are likely to be substantial. They include the economic costs of testing, diagnosis and prostate cancer treatment, which fall not only on the health services, but on men themselves as lost time and out-of-pocket expenses, and on society in the form of lost productivity. Overdiagnosis and overtreatment are recognised consequences of widespread PSA testing, but little is known about how these impact on men in terms of health-related quality-of-life/utility. How these costs balance against the potential benefits of testing at the population-level is not known.

We are working with colleagues at the National University of Ireland, Galway and the University of Oxford to adapt a sophisticated economic model in order to assess cost-effectiveness of PSA testing in Ireland. The model will be modified to reflect prostate cancer incidence, mortality and treatment in Ireland and populated using Irish data as far as possible. Data collected in the PiCTure study from prostate cancer survivors will be used to inform utility estimates. This study will provide the first estimates of cost-effectiveness of systematic PSA testing in Ireland.