Cost implications of PSA screening differ by age
Abstract 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 adve...
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BioMed Central
2018-05-01
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| Series: | BMC Urology |
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| Online Access: | http://link.springer.com/article/10.1186/s12894-018-0344-5 |
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doaj-art-00ca25bb9f274f4b88c14f57e3fe4e302018-08-16T01:37:18ZengBioMed CentralBMC Urology1471-24902018-05-011811810.1186/s12894-018-0344-5Cost implications of PSA screening differ by ageKarthik Rao0Stella Liang1Michael Cardamone2Corinne E. Joshu3Kyle Marmen4Nrupen Bhavsar5William G. Nelson6H. Ballentine Carter7Michael C. Albert8Elizabeth A. Platz9Craig E. Pollack10Johns Hopkins University School of MedicineFinancial Analysis Unit, Johns Hopkins Health SystemFinancial Analysis Unit, Johns Hopkins Health SystemDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public HealthJohns Hopkins Health CareDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public HealthSidney Kimmel Comprehensive Cancer Center at Johns HopkinsDepartment of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of MedicineJohns Hopkins Community Physicians, Johns Hopkins Medical InstitutionsDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public HealthDepartment of Medicine, Johns Hopkins University School of MedicineAbstract 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.http://link.springer.com/article/10.1186/s12894-018-0344-5Prostate cancerScreeningCosts |
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English |
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Article |
| author |
Karthik Rao Stella Liang Michael Cardamone Corinne E. Joshu Kyle Marmen Nrupen Bhavsar William G. Nelson H. Ballentine Carter Michael C. Albert Elizabeth A. Platz Craig E. Pollack |
| spellingShingle |
Karthik Rao Stella Liang Michael Cardamone Corinne E. Joshu Kyle Marmen Nrupen Bhavsar William G. Nelson H. Ballentine Carter Michael C. Albert Elizabeth A. Platz Craig E. Pollack Cost implications of PSA screening differ by age BMC Urology Prostate cancer Screening Costs |
| author_facet |
Karthik Rao Stella Liang Michael Cardamone Corinne E. Joshu Kyle Marmen Nrupen Bhavsar William G. Nelson H. Ballentine Carter Michael C. Albert Elizabeth A. Platz Craig E. Pollack |
| author_sort |
Karthik Rao |
| title |
Cost implications of PSA screening differ by age |
| title_short |
Cost implications of PSA screening differ by age |
| title_full |
Cost implications of PSA screening differ by age |
| title_fullStr |
Cost implications of PSA screening differ by age |
| title_full_unstemmed |
Cost implications of PSA screening differ by age |
| title_sort |
cost implications of psa screening differ by age |
| publisher |
BioMed Central |
| series |
BMC Urology |
| issn |
1471-2490 |
| publishDate |
2018-05-01 |
| description |
Abstract 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. |
| topic |
Prostate cancer Screening Costs |
| url |
http://link.springer.com/article/10.1186/s12894-018-0344-5 |
| _version_ |
1612694304382255104 |