Prostate cancer screening in Thailand: cost-effectiveness analysis and budget impact evaluation

Abstract

Objectives: As public health insurance schemes in Thailand did not included prostate cancer screening in their benefits package, this study aimed to systematically gather the effectiveness and explore the cost effectiveness of difference prostate cancer screening programs for the Thai population and find the financial impact for adapting prostate cancer strategy.

Method: We perform systematic and network meta-analysis, health economic evaluation using Markov’s model to compare four prostate cancer screening strategies with no screening options. And we perform budget impact analysis to assess the potential burden for adopting selected strategy.

Result: The result from systematic review and network meta-analysis suggest the difference of outcome between each prostate cancer screening strategies, ESRPC Scheme yield the most efficacy in term of prostate cancer diagnosis rate (OR 1.65; 95%CI 1.60-1.71) and Goteborg scheme yield the most efficacy in term of prostate cancer related death(OR 0.41; CI 0.31-0.56). Based on the pharmacoeconomic result simulated by Markov’s model, ESRPC and Goteborg schemes compared to no screening strategy yield ICUR at 97,350 THB and 95,554 THB respectively while CAP Scheme and PLCO Schemes are dominated option. For applying prostate cancer screening strategy (ESRPC Scheme), total budget impact per patients estimated for 5 years were 302.58, 601.92, 901.45, 1200.95 and 1500.64 THB respectively

Conclusion: Comparing to No Screening option, ESRPC scheme and Goteborg scheme is Cost Effectiveness strategy options. (ICUR Within threshold of 1XGDP (Around 150,000-200,000 THB). Applying ESRPC screening scheme will affect budget impact in Thailand which needed to weight with clinical benefit as screening will improve life year gained and QALY.