A health economic evaluation of prostate-specific antigen-based risk-stratified prostate cancer screening strategies in Germany

Abstract

Prostate cancer (PCa) screening remains a controversial topic. The value of population-based screening in reducing premature deaths remains unclear, primarily due to over-diagnosis and overtreatments. However, with an increased understanding of the strong linkage between prostate-specific antigen (PSA) dynamics and PCa progression, we can hypothesise that a PSA-based risk-stratified PCa screening can reduce overdiagnosis and overtreatment associated with the current PCa screening strategies.

Therefore, our objective is to evaluate if a PSA-based risk-adapted PCa screening could potentially reduce the total number of screens for the entire population and the screening costs while producing a similar level or better health outcomes, which may lead to a cost-effective screening strategy. To answer these relevant policy and decision-making questions, the Division of Health Economics at the German Cancer Research Center (DKFZ) is currently adapting, extending and recalibrating a prostate cancer natural history model to the German setting. Model calibration involves the identification of suitable observable parameters with sufficiently robust data available (calibration targets).

The most commonly used calibration targets are the disease epidemiological parameters that include but are not limited to incidences, stage distribution at diagnosis, and survival and mortality data. Once the natural history model is calibrated and validated, it can answer several critical questions regarding the cost and value questions related to prostate cancer screening. The project will highly benefit from accessing anonymised Robert Koch Institute individual-level data, primarily used to estimate the relevant epidemiological parameters (calibration targets).