Cost Analysis of Screening for, Diagnosing, and Staging Prostate Cancer Based on a Systematic Review of Published Studies

INTRODUCTION The reported estimates of the economic costs associated with prostate cancer screening, diagnostic testing, and clinical staging are substantial. However, the resource costs (i.e., factors such as physician's time, laboratory tests, patient's time away from work) included in these estimates are unknown. We examined the resource costs for prostate cancer screening, diagnostic tests, and staging; examined how these costs differ in the United States from costs in other industrialized countries; and estimated the cost per man screened for prostate cancer, per man given a diagnostic test, and per man given a clinically staged diagnosis of this disease. METHODS We searched the electronic databases MEDLINE, EMBASE, and CINAHL for articles and reports on prostate cancer published from January 1980 through December 2003. Studies were selected according to the following criteria: the article was published in English; the full text was available for review; the study reported the resource or input cost data used to estimate the cost of prostate cancer testing, diagnosing, or clinical staging; and the study was conducted in an established market economy. We used descriptive statistics, weighted mean, and Monte Carlo simulation methods to pool and analyze the abstracted data. RESULTS Of 262 studies examined, 28 met our selection criteria (15 from the United States and 13 from other industrialized countries). For studies conducted in the United States, the pooled baseline resource cost was $37.23 for screening with prostate-specific antigen (PSA) and $31.77 for screening with digital rectal examination (DRE). For studies conducted in other industrialized countries, the pooled baseline resource cost was $30.92 for screening with PSA and $33.54 for DRE. For diagnostic and staging methods, the variation in the resource costs between the United States and other industrialized countries was mixed. CONCLUSION Because national health resources are limited, a decision about whether to invest in early detection of prostate cancer requires an understanding of the factors included in estimates of the economic cost of this disease. This study may benefit health policy makers charged with allocating resources for prostate cancer.