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Emerging Infectious Diseases Journal
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Volume 4: No. 4, October 2007

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

Figure 1 is a flow chart consisting of boxes that describe the steps in the study selection process. Selection began with a search for all published articles and reports with relevant key words or Medical Subject Headings (MeSH) terms (n=577). Of these, 262 were selected because the title or abstract of the article or report showed evidence of cost. A total of 315 were rejected as they did not include such evidence. The authors obtained full text of the 262 that contained evidence of cost. These were evaluated to determine if the article or report contained the following:

  1. Cost of prostate cancer only (n = 52).
  2. Cost of prostate cancer and cost of other cancer sites (n = 63).
  3. Cost of other cancers and other diseases excluding prostate cancer (n = 147).

If the article contained cost of prostate cancer only or cost of prostate cancer and of other cancer sites, it was evaluated to determine if the article or report met the following criteria:

  1. Was written in the English language.
  2. Was available in full text.
  3. Contained original resource cost data.
  4. Includes cost of screening for, diagnosing, or staging prostate cancer in resource cost data.
  5. Was published from 1980 through 2003.

Articles that met these criteria totaled 28. Of these, 15 were conducted in the United States, and 13 were conducted in other industrialized countries.

A total of 87 articles or reports were rejected for not meeting these criteria.

The total number of articles or reports that contained relevant key words or MeSH terms that were subsequently rejected totaled 549. The total number that met all criteria and were included totaled 28.

Figure 1. Study selection process for Cost Analysis of Screening for, Disagnosing, and Staging Prostate Cancer. CaP indicates prostate cancer. MeSH, medical subject headings.

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Figure 2 is a bar chart comparing the weighted mean costs per man tested for the United States and for other industrialized countries where data for both were available. The x axis is numbered from $0–$45 and calibrated at intervals of $5. It represents cost per man tested in 2003 U.S. dollars. The y axis consists of four sets of bars labeled as follows:

  • Prostate-specific antigen (PSA)
  • Free/total PSA
  • Complex PSA
  • Digital rectal examination

The weighted means for prostate specific antigen were as follows:

  • United States (11 studies): $40.61 ($40.48–$40.74)
  • Other industrialized countries (8 studies): $34.82 ($34.60–$35.05)

The weighted mean for free/total PSA (1 study) was available only for the United States and was $41.56.

The weighted mean for complex PSA (1 study) was available for the United States only and was $20.78.

The weighted means for digital rectal examination were as follows:

  • United States (8 studies): $41.92 ($41.67–$42.16)
  • Other industrialized countries (7 studies): $28.64 ($28.55–$28.73)

Figure 2. Weighted mean cost (in 2003 U.S. dollars) per man screened for prostate cancer, by type of screening method. Numbers in brackets are the number of studies that reported on each testing method. Numbers in parentheses are 95% confidence intervals.Only U.S. studies reported costs for complex PSA or free/total PSA.

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Figure 3 is a bar chart comparing the weighted mean cost per man, by prostate cancer diagnostic method, for the United States and for other industrialized countries. The x axis is calibrated from $0–$400 in intervals of $50. It represents cost (in 2003 U.S. dollars) per man given a diagnosis of prostate cancer. The y axis consists of three sets of bars labeled as follows:

  • Urology consultation
  • Transrectal ultrasound
  • Biopsy

The weighted mean cost for urology consultation was:

  • United States (6 studies): $64.46 ($64.26–$64.65)
  • Other industrialized countries (3 studies): $80.44 ($79.82–$81.06)

The weighted mean cost for transrectal ultrasound was:

  • United States (3 studies): $103.91 ($103.60–$104.23)
  • Other industrialized countries (1 study): $185.04

The weighted mean cost for biopsy was:

  • United States (10 studies): $347.24 ($347.05–$347.44)
  • Other industrialized countries (7 studies): $292.51 ($292.24–$292.78)

Figure 3. Weighted mean cost (in 2003 U.S. dollars) per man given a diagnostic test for prostate cancer, by diagnostic method. Numbers in brackets are the number of studies that reported on each method. Numbers in parentheses are 95% confidence intervals.

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Figure 4 is a bar chart comparing the weighted mean cost per man for prostate cancer staging for the United States and for other industrialized countries. The x axis is calibrated from $0–$350 in intervals of $50. It represents cost for staging per man in 2003 U.S. dollars. The y axis consists of two sets of bars labeled as follows:

  • Pathologic or histologic analysis
  • Clinical staging

The weighted mean cost for pathologic or histologic staging was:

  • United States (6 studies): $69.13 ($68.84–$69.42)
  • Other industrialized countries (4 studies): $239.79 ($239.31–$240.28)

The weighted mean cost for clinical staging was:

  • United States (5 studies): $322.11 ($321.87–$322.34)
  • Other industrialized countries (3 studies): $222.81 ($222.44–$223.19)

Figure 4. Weighted mean cost (in 2003 U.S. dollars) per man given a clinically staged diagnosis of prostate cancer. Numbers in brackets are the number of studies in each staging method. Numbers in parentheses are 95% confidence intervals.

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Figure 5 is a bar graph showing changes in the cost for various testing, diagnosing, and staging of prostate cancer from 1988 to 2002. The x axis is labeled Average change in resource cost and is calibrated from $100 to $250. The y axis consists of seven bars labeled with the following data:

  • Prostate-specific antigen: Cost decreased $20.64 between 1993 and 2002.
  • Digital rectal examination: Cost increased $7.99 between 1993 and 1998
  • Urology consultation: Cost increased $26.23 between 1988 and 1998.
  • Transrectal ultrasound: cost increased $213.53 between 1988 and 1998.
  • Biopsy: Cost decreased $67.23 between 1988 and 2002.
  • Pathologic or histologic analysis: Cost increased $79.19 between 1990 and 2002.
  • Clinical staging: Cost increased $21.91 between 1990 and 1996.

Figure 5. Average changes in resource cost by screening test, diagnostic test, and staging of prostate cancer according to studies conducted in the United States, in 2003 U.S. dollars.

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Figure 6 is a bar graph showing changes in the cost for various methods of screening for, diagnosing, and staging prostate cancer from 1988 to 2002 in other industrialized countries. The x axis is labeled Average change in resource cost and is calibrated from $0 to −$180. The y axis consists of 6 bars labeled with the following data:

  • Prostate-specific antigen: Cost decreased $30.97 between 1991 and 2002.
  • Digital rectal examination: Cost decreased $30.55 between 1990 and 2000
  • Urology consultation: Cost decreased $47.23 between 1995 and 2003.
  • Transrectal ultrasound: cost decreased $48.46 between 1998 and 2002.
  • Biopsy: Cost decreased $160.70 between 1990 and 2002.
  • Pathologic or histologic staging: Cost decreased $32.48 between 1990 and 1995.

Figure 6. Average changes in resource cost, by screening and diagnostic tests for prostate cancer, according to studies conducted in industrialized countries other than the United States, in 2003 U.S.dollars.

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The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.


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