A decision analytic model of prostate cancer screening using prostate-specific antigen and digital rectal exam

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5155-5155
Author(s):  
J. H. Hayes ◽  
M. J. Barry ◽  
P. W. Kantoff ◽  
J. E. Stahl
Keyword(s):  
Prostate Cancer ◽  
Life Expectancy ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Decision Analytic Model ◽  
Digital Rectal Exam ◽  
Psa Screening ◽  
The Impact

5155 Background: PSA-based screening has been widely adopted in the US although a mortality benefit has yet to be demonstrated. The disutility of screening and quality of life of men diagnosed and treated after screening are critical issues in assessing its benefit and harm. The purpose of this model is to estimate the effect of one-time screening for prostate cancer using Prostate Specific Antigen (PSA) and DRE (digital rectal exam) on life expectancy (LE) and Quality Adjusted Life Expectancy (QALE) in the context of current diagnostic and treatment practice. Methods: A semi-Markov state transition simulation describes the relevant health states. Two strategies were compared: 1) Screening - single screening PSA and DRE; 2) No Screening - patients diagnosed after developing symptoms. Markov cycle length was 1 year. Transition probabilities and utility weights were developed from review of the literature and expert opinion. Sensitivity analyses were performed on all parameters. A PSA threshold of 4 ng/mL and age 65 were used for the base case. The model was created using TreeAge software. Results: For our base case, a single screening conferred a LE benefit of 0.37 y (15.86 vs 15.49 y) and a QALE benefit of 0.20 QALYs (15.62 vs 15.42 QALYs). Predicted 10 y cancer specific survival for screen-diagnosed men was 95.7% vs SEER 97.7%. The model predicted 9.5% of screened patients would have metastatic disease at diagnosis vs 5% in SEER (4% unknown stage); in unscreened men, this rate was 18/100,000 vs 15/100,000 in SEER. Sensitivity Analyses of Utilities (SA): The single screen model was relatively insensitive to SA of utilities: a 20% single cycle toll on one-time PSA screening disutility was required to eliminate the benefit of screening. The disutility of positive PSA with negative biopsy slightly affected QALE: a toll of 0.25 QALYs decreased QALE from 15.62 to 15.61 QALYs. Conclusions: Our model reveals a modest benefit to one-time screening for prostate cancer. This one-time screening model is relatively insensitive to utility SA; however, the importance of incorporating psychological effects of PSA screening in recurrent screening is to be determined. The impact of serial screening, lead time, PSA threshold, and cost effectiveness on LE and QALE is being analyzed. No significant financial relationships to disclose.

Prostate cancer and prostate-specific antigen (PSA) screening in Austria

2005 ◽  
Vol 117 (13-14) ◽  
pp. 457-461 ◽  
Author(s):  
Christian Vutuc ◽  
Eva S. Schernhammer ◽  
Gerald Haidinger ◽  
Thomas Waldhör
Keyword(s):  
Prostate Cancer ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Psa Screening

scholarly journals PSA screening for prostate cancer

2017 ◽  
Vol 63 (8) ◽  
pp. 722-725 ◽  
Author(s):  
Marcus V. Sadi
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Early Diagnosis ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Low Grade ◽  
Psa Screening ◽  
Psa Testing ◽  
Baseline Values

Summary Screening of prostate cancer with prostate-specific antigen (PSA) is a highly controversial issue. One part of the controversy is due to the confusion between population screening and early diagnosis, another derives from problems related to the quality of existing screening studies, the results of radical curative treatment for low grade tumors and the complications resulting from treatments that affect the patient’s quality of life. Our review aimed to critically analyze the current recommendations for PSA testing, based on new data provided by the re-evaluation of the ongoing studies and the updated USPSTF recommendation statement, and to propose a more rational and selective use of PSA compared with baseline values obtained at an approximate age of 40 to 50 years.

Hormone Replacement Therapy and Life Expectancy After Prophylactic Oophorectomy in Women With BRCA1/2 Mutations: A Decision Analysis

2004 ◽  
Vol 22 (6) ◽  
pp. 1045-1054 ◽  
Author(s):  
Katrina Armstrong ◽  
J. Sanford Schwartz ◽  
Thomas Randall ◽  
Stephen C. Rubin ◽  
Barbara Weber
Keyword(s):  
Hormone Replacement Therapy ◽  
Life Expectancy ◽  
Decision Analysis ◽  
Replacement Therapy ◽  
Prophylactic Mastectomy ◽  
Hormone Replacement ◽  
Sensitivity Analyses ◽  
Decision Analytic Model ◽  
Prophylactic Oophorectomy ◽  
The Impact

Purpose The decision about prophylactic oophorectomy is difficult for many premenopausal women with BRCA1/2 mutations because of concerns and controversy about the use of hormone replacement therapy (HRT) after oophorectomy. Patients and Methods A Markov decision analytic model used the most current epidemiologic data to assess the expected outcomes of prophylactic oophorectomy with or without HRT (to age 50 years or for life) in cohorts of women with BRCA1/2 mutations. Sensitivity analyses were conducted to assess the impact of alternative assumptions about effects of HRT, effects of prophylactic oophorectomy, and risks of cancer associated with BRCA1/2 mutations. Results In our model, prophylactic oophorectomy lengthened life expectancy in women with BRCA1/2 mutations, irrespective of whether HRT was used after oophorectomy. This gain ranged from 3.34 to 4.65 years, depending on age at oophorectomy. Use of HRT after oophorectomy was associated with relatively small changes in life expectancy (+0.17 to −0.34 years) when HRT was stopped at age 50, but larger decrements in life expectancy if HRT was continued for life (−0.79 to −1.09 years). HRT was associated with a gain in life expectancy of between 0.39 and 0.79 years for mutation carriers undergoing both prophylactic mastectomy and oophorectomy. Conclusion On the basis of the results of this decision analysis, we recommend that women with BRCA1/2 mutations undergo prophylactic oophorectomy after completion of childbearing, decide about short-term HRT after oophorectomy based largely on quality-of-life issues rather than life expectancy, and, if using HRT, consider discontinuing treatment at the time of expected natural menopause, approximately age 50 years.

scholarly journals Values and preferences of men for undergoing prostate-specific antigen screening for prostate cancer: a systematic review

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e025470 ◽  
Author(s):  
Robin W M Vernooij ◽  
Lyubov Lytvyn ◽  
Hector Pardo-Hernandez ◽  
Loai Albarqouni ◽  
Carlos Canelo-Aybar ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Prostate Specific Antigen ◽  
Cancer Mortality ◽  
Prostate Cancer Screening ◽  
Grey Literature ◽  
Specific Antigen ◽  
Risk Of Bias ◽  
Prostate Cancer Mortality ◽  
Psa Screening

ObjectivesTo investigate men’s values and preferences regarding prostate-specific antigen (PSA)-based screening for prostate cancer.DesignSystematic review.Data sourcesWe searched MEDLINE, EMBASE, PsycINFO and grey literature up to 2 September 2017.Eligibility criteriaPrimary studies of men’s values and preferences regarding the benefits and harms of PSA screening.Data extraction and synthesisTwo independent reviewers extracted data and assessed risk of bias with a modified version of a risk of bias tool for values and preferences studies, the International Patient Decision Aid Standards instrument V.3 and the Cochrane Collaboration risk of bias tool.ResultsWe identified 4172 unique citations, of which 11 studies proved eligible. Five studies investigated PSA screening using a direct choice study design, whereas six used decisions aids displaying patient-important outcomes. The direct choice studies used different methodologies and varied considerably in the reporting of outcomes. Two studies suggested that men were willing to forego screening with a small benefit in prostate cancer mortality if it would decrease the likelihood of unnecessary treatment or biopsies. In contrast, one study reported that men were willing to accept a substantial overdiagnosis to reduce their risk of prostate cancer mortality. Among the six studies involving decision aids, willingness to undergo screening varied substantially from 37% when displaying a hypothetical reduction in mortality of 10 per 1000 men, to 44% when displaying a reduction in mortality of 7 per 1000. We found no studies that specifically investigated whether values and preferences differed among men with family history, of African descent or with lower socioeconomic levels.ConclusionThe variability of men’s values and preferences reflect that the decision to screen is highly preference sensitive. Our review highlights the need for shared decision making in men considering prostate cancer screening.Trial registration numberCRD42018095585.

scholarly journals 80. Pharmacoeconomic Analysis Comparing the Empiric Utilization of Cefepime Versus Piperacillin/tazobactam

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S57-S58
Author(s):  
Kelsey Olmack ◽  
Curtis D Collins
Keyword(s):  
Pharmacoeconomic Analysis ◽  
Hospital Setting ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Decision Analytic Model ◽  
Empiric Treatment ◽  
Life Years ◽  
The Cost ◽  
The Impact

Abstract Background In the hospital setting, cefepime (CFP) and piperacillin/tazobactam (PTZ) are among the most commonly utilized antipseudomonal agents in the empiric treatment of nosocomial and healthcare-associated infections. Institutional preference of CFP or PTZ as the preferred antipseudomonal antibiotic varies. Recent literature suggests each may be associated with increased rates of harmful adverse effects including Clostridiodes difficile infection (CDI) and acute kidney injury (AKI). The objective of this study is to perform a pharmacoeconomic analysis comparing CFP versus PTZ for empiric antibiotic treatment in patients where Pseudomonas aeruginosa is a concern. Methods We performed a cost-utility analysis comparing CFP and PTZ for empiric utilization in the hospital setting by creating a decision analytic model from the hospital perspective. Model variables were populated utilizing published clinical and economic data including incidence of AKI and CDI, their associated costs and mortality, and the cost of antibiotic therapy. Secondary and univariate sensitivity analyses tested the impact of model uncertainties and the robustness of our model. A willingness to pay (WTP) threshold of $0 was utilized. Results Results of our base-case model predicted that the use of CFP dominated PTZ as empiric utilization was less expensive ($7690 vs. $9331) and associated with a higher quality-adjusted life-years (QALY) (0.9193 vs. 0.9191) compared to the use of PTZ. Several variables had the potential to impact base case results. PTZ became cost-effective at our WTP threshold if CFP nephrotoxicity rates increased to 17.3%, the PTZ nephrotoxicity decreased to 28.5%, or if the cost of nephrotoxicity was less than $17,457. No other model variables, including incidence of CDI, impacted base case results. Sensitivity Analysis on Cefepime Clostridioides difficile Infection Incidence and Piperacillin/tazobactam Nephrotoxicity Conclusion Results of our model showed that CFP dominated PTZ for the empiric treatment of nosocomial infections. The model was sensitive to variation in CFP and PTZ nephrotoxicity rates. Disclosures All Authors: No reported disclosures

Sign in / Sign up

Export Citation Format

Share Document