Prostate cancer screening to save thousands of lives and billions of dollars

Introducing a nationwide screening programme for prostate cancer could save thousands of lives and generate billions of dollars in health gains over the next generation, according to modelling conducted by the New Zealand Institute of Economic Research (NZIER) for the Prostate Cancer Foundation New Zealand.

NZIER’s analysis modelled a two-district pilot screening programme in Waitematā and Tairāwhiti. It showed that an investment of around $1.6 million a year for 20 years was expected to return over $100 million to the health system in cost savings and generate over half a billion in health gains for Waitematā and Tairāwhiti men over their lifetimes. Nearly $1 million in total personal income loss to working-age men could also be expected to be avoided.

“More than 4000 men are diagnosed and over 700 die from prostate cancer every year,” said Prostate Cancer Foundation President Danny Bedingfield.

“Current opportunistic PSA testing results in inefficient resource use and inequitable outcomes. While the value of PSA-based population screening is debated, the true value for New Zealand cannot be known until a pilot programme has been run and evaluated.

“NZIER’s modelling offers the potential to better understand both the equity dimensions of early detection and the impact of specialist nurse workforce and increased use of modern diagnostic technologies.”

NZIER described prostate cancer screening as “a rare opportunity to achieve health system savings along with health gains. For every quality-adjusted health year (QALY) gained through prostate cancer screening, health system savings of over $8,000 are expected. When compared with other health interventions, this represents extraordinary value.”

The comparable savings figure for bowel cancer screening was $4,850, while many funded interventions and interventions considered cost-effective generate net costs for the health system in delivering health benefits, according to NZIER.

Interventions with net costs included:

• HPV screening (a cost per QALY of $5,170)
• Increasing use of thrombolysis for ischaemic stroke ($7,380)
• Acute stroke units in NZ hospitals ($7,960)
• Border closure in influenza pandemic ($14,400)
• Antiviral stockpiling for future influenza pandemics ($33,200)
• Medicines funded by Pharmac (average) ($41,756)

Bedingfield said prostate cancer was the second-leading cause of cancer death in men yet there is no national early detection programme in place.

“Early detection of cancer means better clinical outcomes and lives saved, as is the case with other early detection programmes.

“We want to walk before we run. After a trial is completed, potentially a national early-detection scheme could be leveraged off existing infrastructure in place for breast, cervical and bowel screening programmes.

“We’ve been asking all political parties to support the implementation of a pilot scheme, which would be a low-risk, sensible way to learn, and then scale-up from there. And our indicative numbers suggest this is also a low-cost option with significant upside.

Bedingfield said significant advances in technology and improved diagnostic methods mean previous risks from prostate treatment have been reduced, and the latest research clearly shows that a comprehensive early-detection programme holds the promise of halving mortality from the disease.

“There has been a lot of discussion on men’s health. But now is the time to commit to some action if we are serious about making a difference. An investment of $1.6 million a year for a focussed trial is not a lot to ask for to save lives.”