Affordable Access

deepdyve-link
Publisher Website

Interpreting cost-effectiveness ratios in a cost-effectiveness analysis of risk-tailored prostate screening: A critique of Callender et al.

Authors
  • O'Mahony, James F1
  • 1 Centre for Health Policy and Management, University of Dublin, Dublin, D02 PN40, Ireland. , (Ireland)
Type
Published Article
Journal
HRB open research
Publication Date
Jan 01, 2020
Volume
3
Pages
23–23
Identifiers
DOI: 10.12688/hrbopenres.13043.1
PMID: 32596631
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Callender et al. recently published a model-based cost-effectiveness analysis of a risk-tailored approach to prostate cancer screening. It considers the costs and effects of prostate cancer screening offered to all men aged 55-69 without any risk selection and, alternatively, over a range of risk-tailored strategies in which screen eligibility is determined by a varying threshold of disease risk. The analysis finds that the strategy of screening men once they reach a 10-year absolute risk of disease of 5% or more is cost-effective in a UK context. I believe there are several problems with the study, mostly stemming from an incorrect interpretation of the cost-effectiveness estimates. I show that one reinterpretation of their results indicates that screening is much less cost-effective than the original analysis suggests, indicating that screening should be restricted to a much smaller group of higher risk men. More broadly, I explain the challenges of attempting to meaningfully reinterpret the originally published results due to the simulation of non-mutually exclusive intervention strategies. Finally, I consider the relevance of considering sufficient alternative screening intensities. This critique highlights the need for appropriate interpretation of cost-effectiveness results for policymakers, especially as risk stratification within screening becomes increasingly feasible. Copyright: © 2020 O'Mahony JF.

Report this publication

Statistics

Seen <100 times