Background: The aim was to estimate the lifetime cost in relation to the extra number of detected localized and potentially curable cancers, and to estimate the economic impact on health care of repeated screening for prostate cancer in Sweden in a cohort of men aged 50-64 years.
Material and Methods: From the total male population in the city of Gothenburg born between 1930-1944 (n=32,298), 10,000 men were randornized to prostate cancer screening beginning in January 1995, and 10,000 men were randomized to serve as a control group. PSA tests were offered every 2nd year until the age of 70. All health care costs for administration of the screening programme, screening tests, diagnostic procedures, and treatments were included. Data on detected cancers were collected from the prospective programme and from patient records. A Markov model was developed to calculate the cost-effectiveness and the total extra cost of the screening programme.
Results: For the period from the start of the screening programme until death, the estimates were 17.7 extra localized cancers per 1,000 men and 7.3 extra cases of curative aimed treatments per 1,000 men. The incremental cost per extra detected localized cancer was calculated at 98,000 SEK, and per cancer with curative aimed treatment the figure was 236,000 SEK. Introducing this screening programme for prostate cancer in Sweden would yield 92 million SEK annually in additional costs for screening and management compared to a non-screening strategy.
Conclusion: Introduction of prostate cancer screening with PSA would increase the total economic burden of prostate cancer for society by approximately 30 percent. Due to the lack of scientific data concerning possible survival benefits from prostate cancer screening, we must wait several years before the true cost-effectiveness of the programme can be calculated.