Interpreting cost-effectiveness ratios in a cost-effectiveness analysis of risk-tailored prostate screening: A critique of Callender .
AuthorsO'Mahony, James F
incremental-cost effectiveness ratio
MetadataShow full item record
JournalHRB open research
AbstractCallender et al. recently published a model-based cost-effectiveness analysis of a risk-tailored approach to prostate cancer screening. It considers the costs and effects of prostate cancer screening offered to all men aged 55-69 without any risk selection and, alternatively, over a range of risk-tailored strategies in which screen eligibility is determined by a varying threshold of disease risk. The analysis finds that the strategy of screening men once they reach a 10-year absolute risk of disease of 5% or more is cost-effective in a UK context. I believe there are several problems with the study, mostly stemming from an incorrect interpretation of the cost-effectiveness estimates. I show that one reinterpretation of their results indicates that screening is much less cost-effective than the original analysis suggests, indicating that screening should be restricted to a much smaller group of higher risk men. More broadly, I explain the challenges of attempting to meaningfully reinterpret the originally published results due to the simulation of non-mutually exclusive intervention strategies. Finally, I consider the relevance of considering sufficient alternative screening intensities. This critique highlights the need for appropriate interpretation of cost-effectiveness results for policymakers, especially as risk stratification within screening becomes increasingly feasible.
- Polygenic risk-tailored screening for prostate cancer: A benefit-harm and cost-effectiveness modelling study.
- Authors: Callender T, Emberton M, Morris S, Eeles R, Kote-Jarai Z, Pharoah PDP, Pashayan N
- Issue date: 2019 Dec
- Comparative effectiveness of alternative prostate-specific antigen--based prostate cancer screening strategies: model estimates of potential benefits and harms.
- Authors: Gulati R, Gore JL, Etzioni R
- Issue date: 2013 Feb 5
- Cost-effectiveness of prostate cancer screening: a simulation study based on ERSPC data.
- Authors: Heijnsdijk EA, de Carvalho TM, Auvinen A, Zappa M, Nelen V, Kwiatkowski M, Villers A, Páez A, Moss SM, Tammela TL, Recker F, Denis L, Carlsson SV, Wever EM, Bangma CH, Schröder FH, Roobol MJ, Hugosson J, de Koning HJ
- Issue date: 2015 Jan
- The cost-effectiveness of using chronic kidney disease risk scores to screen for early-stage chronic kidney disease.
- Authors: Yarnoff BO, Hoerger TJ, Simpson SK, Leib A, Burrows NR, Shrestha SS, Pavkov ME, Centers for Disease Control and Prevention CKD Initiative.
- Issue date: 2017 Mar 13
- Economic Analysis of Prostate-Specific Antigen Screening and Selective Treatment Strategies.
- Authors: Roth JA, Gulati R, Gore JL, Cooperberg MR, Etzioni R
- Issue date: 2016 Jul 1