Polygenic risk-tailored screening for prostate cancer: A benefit–harm and cost-effectiveness modelling study


Autoři: Tom Callender aff001;  Mark Emberton aff002;  Steve Morris aff001;  Ros Eeles aff003;  Zsofia Kote-Jarai aff003;  Paul D. P. Pharoah aff004;  Nora Pashayan aff001
Působiště autorů: Department of Applied Health Research, Institute of Epidemiology & Health Care, University College London, London, United Kingdom aff001;  Faculty of Medical Sciences, School of Life & Medical Sciences, University College London, London, United Kingdom aff002;  The Institute of Cancer Research, London, United Kingdom aff003;  Departments of Oncology, and Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Cambridge, United Kingdom aff004
Vyšlo v časopise: Polygenic risk-tailored screening for prostate cancer: A benefit–harm and cost-effectiveness modelling study. PLoS Med 16(12): e32767. doi:10.1371/journal.pmed.1002998
Kategorie: Research Article
doi: 10.1371/journal.pmed.1002998

Souhrn

Background

The United States Preventive Services Task Force supports individualised decision-making for prostate-specific antigen (PSA)-based screening in men aged 55–69. Knowing how the potential benefits and harms of screening vary by an individual’s risk of developing prostate cancer could inform decision-making about screening at both an individual and population level. This modelling study examined the benefit–harm tradeoffs and the cost-effectiveness of a risk-tailored screening programme compared to age-based and no screening.

Methods and findings

A life-table model, projecting age-specific prostate cancer incidence and mortality, was developed of a hypothetical cohort of 4.48 million men in England aged 55 to 69 years with follow-up to age 90. Risk thresholds were based on age and polygenic profile. We compared no screening, age-based screening (quadrennial PSA testing from 55 to 69), and risk-tailored screening (men aged 55 to 69 years with a 10-year absolute risk greater than a threshold receive quadrennial PSA testing from the age they reach the risk threshold). The analysis was undertaken from the health service perspective, including direct costs borne by the health system for risk assessment, screening, diagnosis, and treatment. We used probabilistic sensitivity analyses to account for parameter uncertainty and discounted future costs and benefits at 3.5% per year. Our analysis should be considered cautiously in light of limitations related to our model’s cohort-based structure and the uncertainty of input parameters in mathematical models. Compared to no screening over 35 years follow-up, age-based screening prevented the most deaths from prostate cancer (39,272, 95% uncertainty interval [UI]: 16,792–59,685) at the expense of 94,831 (95% UI: 84,827–105,630) overdiagnosed cancers. Age-based screening was the least cost-effective strategy studied. The greatest number of quality-adjusted life-years (QALYs) was generated by risk-based screening at a 10-year absolute risk threshold of 4%. At this threshold, risk-based screening led to one-third fewer overdiagnosed cancers (64,384, 95% UI: 57,382–72,050) but averted 6.3% fewer (9,695, 95% UI: 2,853–15,851) deaths from prostate cancer by comparison with age-based screening. Relative to no screening, risk-based screening at a 4% 10-year absolute risk threshold was cost-effective in 48.4% and 57.4% of the simulations at willingness-to-pay thresholds of GBP£20,000 (US$26,000) and £30,000 ($39,386) per QALY, respectively. The cost-effectiveness of risk-tailored screening improved as the threshold rose.

Conclusions

Based on the results of this modelling study, offering screening to men at higher risk could potentially reduce overdiagnosis and improve the benefit–harm tradeoff and the cost-effectiveness of a prostate cancer screening program. The optimal threshold will depend on societal judgements of the appropriate balance of benefits–harms and cost-effectiveness.

Klíčová slova:

Biopsy – Cancer detection and diagnosis – Cancer prevention – Cancer screening – Cancer treatment – Cost-effectiveness analysis – Health screening – Prostate cancer


Zdroje

1. US Preventive Services Task Force, Grossman DC, Curry SJ, Owens DK, Bibbins-Domingo K, Caughey AB, et al. Screening for Prostate Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319: 1901–1913. doi: 10.1001/jama.2018.3710 29801017

2. Pashayan N, Duffy SW, Neal DE, Hamdy FC, Donovan JL, Martin RM, et al. Implications of polygenic risk-stratified screening for prostate cancer on overdiagnosis. Genet Med. 2015;17: 789–795. doi: 10.1038/gim.2014.192 25569441

3. UK National Screening Committee. The UK NSC recommendation on Prostate cancer screening/PSA testing in men over the age of 50 [Internet]. [cited 2018 Jul 13]. Available from: https://legacyscreening.phe.org.uk/prostatecancer

4. Matejcic M, Saunders EJ, Dadaev T, Brook MN, Wang K, Sheng X, et al. Germline variation at 8q24 and prostate cancer risk in men of European ancestry. Nat Commun. 2018;9: 4616. doi: 10.1038/s41467-018-06863-1 30397198

5. Eeles R, Goh C, Castro E, Bancroft E, Guy M, Olama AA Al, et al. The genetic epidemiology of prostate cancer and its clinical implications. Nat Rev Urol. 2014;11: 18–31. doi: 10.1038/nrurol.2013.266 24296704

6. Pharoah PDP, Antoniou A, Bobrow M, Zimmern RL, Easton DF, Ponder BAJ. Polygenic susceptibility to breast cancer and implications for prevention. Nat Genet. 2002;31: 33–36. doi: 10.1038/ng853 11984562

7. Office for National Statistics. Population estimates [Internet]. [cited 2018 Jul 17]. Available from: https://www.nomisweb.co.uk/query/select/getdatasetbytheme.asp?opt=3&theme=&subgrp=

8. Schröder FH, Hugosson J, Roobol MJ, Tammela TLJ, Zappa M, Nelen V, et al. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet. 2014;384: 2027–2035. doi: 10.1016/S0140-6736(14)60525-0 25108889

9. Dadaev T, Saunders EJ, Newcombe PJ, Anokian E, Leongamornlert DA, Brook MN, et al. Fine-mapping of prostate cancer susceptibility loci in a large meta-analysis identifies candidate causal variants. Nat Commun. 2018;9: 2256. doi: 10.1038/s41467-018-04109-8 29892050

10. DevCan [Internet]. Bethesda, MD: US NIH National Cancer Institute. [cited 2018 Jul 13] Available from: https://surveillance.cancer.gov/devcan/download

11. Department of Health. NHS reference costs 2015 to 2016 [Internet]. [cited 2018 Jul 19]. Available from: https://www.gov.uk/government/publications/nhs-reference-costs-2015-to-2016

12. Curtis L, Burns A. Unit Costs of Health and Social Care 2016 [Internet]. [cited 2018 Jul 19] Available from: https://www.pssru.ac.uk/pub/uc/uc2016/full.pdf?uc=2016-full

13. Thorn JC, Turner EL, Hounsome L, Walsh E, Down L, Verne J, et al. Validating the use of hospital episode statistics data and comparison of costing methodologies for economic evaluation: An end-of-life case study from the cluster randomised trial of PSA testing for prostate cancer (CAP). BMJ Open. 2016;6: 1–7. doi: 10.1136/bmjopen-2016-011063 27130167

14. Public Health England & Cancer Research UK. Chemotherapy, Radiotherapy and Surgical Tumour Resections in England [Internet]. [cited 2018 Jul 19]. Available from: https://www.cancerdata.nhs.uk/treatments

15. The National Prostate Cancer Audit Annual Report 2017 [Internet]. [cited 2018 Jul 19] London; 2017. Available from: https://www.npca.org.uk.

16. NICE. Costing statement: prostate cancer: diagnosis and treatment [Internet]. [cited 2018 Jul 19] London; 2014. Available from: https://www.nice.org.uk/guidance/cg179/resources/costing-statement-248688109

17. Pashayan N, Duffy SW, Pharoah P, Greenberg D, Donovan J, Martin RM, et al. Mean sojourn time, overdiagnosis, and reduction in advanced stage prostate cancer due to screening with PSA: Implications of sojourn time on screening. Br J Cancer. 2009;100: 1198–1204. doi: 10.1038/sj.bjc.6604973 19293796

18. Ilic D, Djulbegovic M, Jung JH, Hwang EC, Zhou Q, Cleves A, et al. Prostate cancer screening with prostate-specific antigen (PSA) test: a systematic review and meta-analysis. BMJ. 2018;362: k3519. doi: 10.1136/bmj.k3519 30185521

19. Ara R, Brazier JE. Using health state utility values from the general population to approximate baselines in decision analytic models when condition-specific data are not available. Value Heal. 2011;14: 539–545. doi: 10.1016/j.jval.2010.10.029 21669378

20. Heijnsdijk EA, Wever EM, Auvinen A, Hugosson J, Ciatto S, Nelen V, et al. Quality-of-life effects of prostate-specific antigen screening. N Engl J Med. 2012;367: 595–605. doi: 10.1056/NEJMoa1201637 22894572

21. National Collaborating Centre for Cancer. Prostate Cancer: Diagnosis and Treatment: Clinical Guideline [Internet]. [cited 2018 Jul 20] London; 2014. Available from: https://www.nice.org.uk/guidance/CG175

22. NICE. Prostate cancer: NICE Pathway [Internet]. [cited 2018 Jul 20]. Available from: https://pathways.nice.org.uk/pathways/prostate-cancer#path=view%3A/pathways/prostate-cancer/prostate-cancer-overview.xml&content=view-index

23. Hamdy FC, Donovan JL, Lane JA, Mason M, Metcalfe C, Holding P, et al. 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer. N Engl J Med. 2016;375: 1415–1424. doi: 10.1056/NEJMoa1606220 27626136

24. NICE. Prostate cancer: Protocol for active surveillance: Implementing the NICE guideline on prostate cancer (CG175) [Internet]. [cited 2018 Jul 19] London; 2014. Available from: https://www.nice.org.uk/guidance/cg175/resources/cg175-prostate-cancer-protocol-for-active-surveillance2

25. NICE. Docetaxel for the treatment of hormone-refractory metastatic prostate cancer. Technology appraisal (TA101) [Internet]. [cited 2018 Jul 30] London; 2006. Available from: https://www.nice.org.uk/guidance/ta101/chapter/4-Evidence-and-interpretation

26. Round J, Jones L, Morris S. Estimating the cost of caring for people with cancer at the end of life: A modelling study. Palliat Med. 2015;29: 899–907. doi: 10.1177/0269216315595203 26199134

27. Pharoah PDP, Sewell B, Fitzsimmons D, Bennett HS, Pashayan N. Cost effectiveness of the NHS breast screening programme: Life table model. BMJ. 2013;346: 1–8. doi: 10.1136/bmj.f2618 23661112

28. NICE. Guide to the methods of technology appraisal 2013 [Internet]. [cited 2018 Jun 15] London: National Institute for Health and Care Excellence; 2013. Available from: https://www.nice.org.uk/process/pmg9/resources/guide-to-the-methods-of-technology-appraisal-2013-pdf-2007975843781

29. Fox-Rushby J, Cairns J, editors. Economic evaluation. Maidenhead, England: Open University Press; 2005.

30. Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. Consolidated health economic evaluation reporting standards (CHEERS) statement. Value Heal. 2013;16: e1–e5. doi: 10.1016/j.jval.2013.02.010 23538200

31. Pashayan N, Morris S, Gilbert FJ, Pharoah PDP. Cost-effectiveness and Benefit-to-Harm Ratio of Risk-Stratified Screening for Breast Cancer: A Life-Table Model. JAMA Oncol. 2018;4: 1504–1510. doi: 10.1001/jamaoncol.2018.1901 29978189

32. Burton H, Chowdhury S, Dent T, Hall A, Pashayan N, Pharoah P. Public health implications from COGS and potential for risk stratification and screening. Nat Genet. 2013;45: 349–351. doi: 10.1038/ng.2582 23535723

33. Annual Report of the Chief Medical Officer 2016 [Internet]. [cited 2018 Sept 01] London; 2016. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/631043/CMO_annual_report_generation_genome.pdf

34. von Wagner C, Baio G, Raine R, Snowball J, Morris S, Atkin W, et al. Inequalities in participation in an organized national colorectal cancer screening programme: Results from the first 2.6 million invitations in England. Int J Epidemiol. 2011;40: 712–718. doi: 10.1093/ije/dyr008 21330344

35. Solmi F, Von Wagner C, Kobayashi LC, Raine R, Wardle J, Morris S. Decomposing socio-economic inequality in colorectal cancer screening uptake in England. Soc Sci Med. 2015;134: 76–86. doi: 10.1016/j.socscimed.2015.04.010 25917138

36. Gulati R, Cheng HH, Lange PH, Nelson PS, Etzioni R. Screening men at increased risk for prostate cancer diagnosis: Model estimates of benefits and harms. Cancer Epidemiol Biomarkers Prev. 2017;26: 222–227. doi: 10.1158/1055-9965.EPI-16-0434 27742670

37. Roth JA, Gulati R, Gore JL, Cooperberg MR, Etzioni R. Economic Analysis of Prostate-Specific Antigen Screening and Selective Treatment Strategies. JAMA Oncol. 2016;2: 890–898. doi: 10.1001/jamaoncol.2015.6275 27010943

38. Downing A, Wright P, Hounsome L, Selby P, Wilding S, Watson E, et al. Quality of life in men living with advanced and localised prostate cancer in the UK: a population-based study. Lancet Oncol. 2019;2045. doi: 10.1016/S1470-2045(18)30780-0

39. Seibert TM, Fan CC, Wang Y, Zuber V, Karunamuni R, Parsons JK, et al. Polygenic hazard score to guide screening for aggressive prostate cancer: development and validation in large scale cohorts. BMJ. 2018;360: j5757. doi: 10.1136/bmj.j5757 29321194

Štítky
Interní lékařství

Článek vyšel v časopise

PLOS Medicine


2019 Číslo 12

Nejčtenější v tomto čísle

Tomuto tématu se dále věnují…


Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

Farmaceutická péče o pacienta s inhalační terapií
nový kurz
Autoři: Mgr. Ondřej Šimandl

Revmatoidní artritida: včas a k cíli
Autoři: MUDr. Heřman Mann

Jistoty a nástrahy antikoagulační léčby aneb kardiolog - neurolog - farmakolog - nefrolog - právník diskutují
Autoři: doc. MUDr. Štěpán Havránek, Ph.D., prof. MUDr. Roman Herzig, Ph.D., doc. MUDr. Karel Urbánek, Ph.D., prim. MUDr. Jan Vachek, MUDr. et Mgr. Jolana Těšínová, Ph.D.

Léčba akutní pooperační bolesti
Autoři: doc. MUDr. Jiří Málek, CSc.

Nové antipsychotikum kariprazin v léčbě schizofrenie
Autoři: prof. MUDr. Cyril Höschl, DrSc., FRCPsych.

Všechny kurzy
Přihlášení
Zapomenuté heslo

Nemáte účet?  Registrujte se

Zapomenuté heslo

Zadejte e-mailovou adresu se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se