title: Testicular self-examination and testicular cancer: a cost-utility analysis.
abstract: The United States Preventive Services Task Force (USPSTF) has recommended against testicular self-examinations (TSE) or clinical examination for testicular cancer screening. However, in this recommendation there was no consideration of the significant fiscal cost of treating advanced disease versus evaluation of benign disease. In this study, a cost-utility validation for TSE was performed. The cost of treatment for an advanced-stage testicular tumor (both seminomatous and nonseminomatous) was compared to the cost of six other scenarios involving the clinical assessment of a testicular mass felt during self-examination (four benign and two early-stage malignant). Medicare reimbursements were used as an estimate for a national cost standard. The total treatment cost for an advanced-stage seminoma ($48,877) or nonseminoma ($51,592) equaled the cost of 313-330 benign office visits ($156); 180-190 office visits with scrotal ultrasound ($272); 79-83 office visits with serial scrotal ultrasounds and labs ($621); 6-7 office visits resulting in radical inguinal orchiectomy for benign pathology ($7,686) or 2-3 office visits resulting in treatment and surveillance of an early-stage testicular cancer ($17,283: seminoma, $26,190: nonseminoma). A large number of clinical evaluations based on the TSE for benign disease can be made compared to the cost of one missed advanced-stage tumor. An average of 2.4 to 1 cost benefit ratio was demonstrated for early detected testicular cancer versus advanced-stage disease.
authors.affiliation: Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, 66160.
authors.forename: Michael
authors.initials: M
authors.lastname: Aberger
authors.forename: Bradley
authors.initials: B
authors.lastname: Wilson
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Holzbeierlein
authors.forename: Tomas L
authors.initials: TL
authors.lastname: Griebling
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Nangia
mesh_terms: D000293:Adolescent; D000328:Adult; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods; D006801:Humans; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis / Q000191:economics / Q000473:pathology; D016353:Self-Examination / Q000191:economics* / Q000379:methods*; D018239:Seminoma / Q000175:diagnosis / Q000191:economics / Q000473:pathology; D013736:Testicular Neoplasms / Q000175:diagnosis* / Q000191:economics* / Q000473:pathology; D014481:United States; D055815:Young Adult
keywords: Cost analysis; prevention; screening; self-examination; testis cancer
references.citation: J Urol. 2005 Mar;173(3):933-7
references.pmid: 15711342
references.citation: J Urol. 2003 Nov;170(5):1783-6
references.pmid: 14532776
references.citation: Lancet. 2004 Jan 3;363(9402):40-2
references.pmid: 14723995
references.citation: Radiology. 2001 Feb;218(2):359-63
references.pmid: 11161147
references.citation: J Urol. 1990 Mar;143(3):520-3
references.pmid: 2304163
references.citation: Epidemiol Rev. 2011;33:20-35
references.pmid: 21666224
references.citation: Ann Intern Med. 2010 Sep 21;153(6):396-9
references.pmid: 20855803
references.citation: Lancet. 1981 Oct 31;2(8253):970-3
references.pmid: 6117736
references.citation: Urol J. 2011 Winter;8(1):60-5
references.pmid: 21404205
references.citation: Ann Intern Med. 2011 Apr 5;154(7):483-6
references.pmid: 21464350
references.citation: Br J Gen Pract. 2004 Jan;54(498):25-32
references.pmid: 14965403
references.citation: Clin J Sport Med. 2005 Jan;15(1):22-6
references.pmid: 15654187