title: Impact of improvement in specificity of primary screening test on total cost of prostate cancer mass screening.
abstract: OBJECTIVE
  Improvement in the specificity of primary screening tests, without significant cost elevation of the assay, provides cost savings in prostate cancer screening programs by reducing unnecessary secondary screening procedures. The purpose of this study was to evaluate the economic impact of improvement in the specificity of primary screening tests and to estimate the socially acceptable cost elevation for improved specificity.
  
  
  METHODS
  A decision-analytic model was designed to evaluate the total costs of prostate cancer mass screening according to the changes in the specificity and the cost of the primary screening test. All assumed factors were tested by three-way sensitivity analyses incorporating cost and specificity.
  
  
  RESULTS
  The base case analysis showed that a 1% improvement in the specificity of the primary screening test provides a $1.19 cost reduction per participant. Sensitivity analyses showed that an acceptable cost elevation for a 1% improvement in the specificity ranged from 0.68 to 2.90 $/% with respect to changes in several factors in the screening program.
  
  
  CONCLUSIONS
  The specificity and cost of the primary screening test has a significant economical impact on prostate cancer mass screening. For each screening program, it should be taken into consideration whether the cost of the new test deserves the specificity.
authors.affiliation: Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Rei
authors.initials: R
authors.lastname: Goto
authors.forename: Tsuguya
authors.initials: T
authors.lastname: Fukui
authors.forename: Osamu
authors.initials: O
authors.lastname: Ogawa
mesh_terms: D003661:Decision Support Techniques; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008962:Models, Theoretical; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012680:Sensitivity and Specificity