title: Cost-effectiveness of percent free PSA for prostate cancer detection in men with a total PSA of 4-10 ng/ml.
abstract: OBJECTIVE
  To assess the cost-effectiveness of two diagnostic strategies for prostate cancer in men with prostate-specific antigen (PSA) levels of 4-10 ng/ml and normal digital rectal examination (DRE).
  
  
  METHODS
  Cost-effectiveness analysis was performed using a decision tree model. Data collection and a systematic review of patients at the Urology Department (Carlos Haya Hospital) were made. 101 patients over the age of 40 with PSA levels of 4-10 ng/ml and normal DRE were selected. Transrectal ultrasound-guided prostate biopsy (TRUS-Bx) and percent free PSA testing prior to TRUS-Bx were performed. The outcome measures used were the incremental cost-effectiveness ratio, and costs were calculated through activity-based costing. The effectiveness was measured by means of the number of detected cases, test utility and actual cases (detected cases minus lost cases).
  
  
  RESULTS
  Using base-case analysis, the strategy of percent free PSA + TRUS-Bx was found to be the most cost-effective. The incremental cost-effectiveness ratio for free PSA + TRUS-Bx compared with TRUS-Bx was EUR 2,277.40. Strategy 2 (TRUS-Bx) would be more cost-effective if the cost of percent free PSA increased to EUR 21.64 or if prostate cancer prevalence increased to 26%.
  
  
  CONCLUSIONS
  The use of percent free PSA prior to TRUS-Bx is the most cost-effective diagnostic strategy. However, this result is very sensitive and strategy 2 (TRUS-Bx) would be more cost-effective if the cost of the percent free PSA increased to EUR 21.64 or if the prevalence of prostate cancer increased to above 26%.
authors.affiliation: Andalusian School of Public Health, Granada, Spain. clara.bermudez.easp@juntadeandalucia.es
authors.forename: Clara
authors.initials: C
authors.lastname: Bermúdez-Tamayo
authors.forename: Jose Jesús
authors.initials: JJ
authors.lastname: Martín Martín
authors.forename: Maria del Puerto López del Amo
authors.initials: Mdel P
authors.lastname: González
authors.forename: Carmen
authors.initials: C
authors.lastname: Pérez Romero
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D051517:Digital Rectal Examination / Q000191:economics / Q000379:methods; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood / Q000191:economics*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000191:economics; D012016:Reference Values; D012680:Sensitivity and Specificity; D013030:Spain; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000191:economics* / Q000379:methods
chemical_list: D017430:Prostate-Specific Antigen