前列腺健康指数(PHI)在前列腺癌筛查中的作用:通过模拟模型进行成本最小化分析。

IF 2.9 2区 医学 Q2 UROLOGY & NEPHROLOGY
Leire Rius Bilbao, Urko Aguirre Larracoechea, Carmen Valladares Gomez, Javier Mar, Carmen Mar Medina
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引用次数: 0

摘要

背景:前列腺癌(PCa)是全球最常见的癌症,发病率不断上升,尤其是在欧洲。前列腺特异性抗原(PSA)检测常常导致过度诊断和不必要的活检。本研究旨在评估将前列腺健康指数(PHI)作为前列腺癌筛查计划的生物标志物以减少不必要的活检和优化医疗保健系统成本的成本节约潜力。方法:利用临床观察性研究的数据建立模拟模型。在1万名年龄在50-70岁、PSA水平为3-10 ng/mL的男性模拟人群中,使用PHI值来确定活检决定。Logistic回归模拟了PHI与临床显著性PCa (csPCa)之间的相关性。测试了三种csPCa流行情况(10%、20%和30%),以评估成本最小化效应。决策树比较了pi引导活检方法与传统的基于psa的策略。结果:与传统的基于psa的策略相比,pi引导的方法减少了高达49.7%的阴性和低级别活检,并证明了成本节约。使用PHI可为每位患者节省233欧元的csPCa检测成本。PHI途径的平均成本为681欧元,而传统的基于psa的途径的平均成本为915欧元。然而,该研究对合成数据的依赖以及数据集中MRI的有限纳入可能会影响结果的普遍性。结论:将PHI纳入前列腺癌筛查可减少过度诊断、不必要的活检和总体医疗保健费用。需要进一步的前瞻性研究来证实PHI作为一种具有成本效益的反射测试的作用,并将其纳入更广泛的前列腺癌筛查策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Role of prostate health index (PHI) in prostate cancer screening: cost minimization analysis through simulation modelling.

Background: Prostate cancer (PCa) is the most frequently diagnosed cancer globally, with rising incidence rates, particularly in Europe. Prostate specific antigen (PSA) testing, often leads to overdiagnosis and unnecessary biopsies. This study aims to assess the cost-saving potential of incorporating the Prostate Health Index (PHI) as a biomarker in PCa screening programmes to reduce unnecessary biopsies and optimize costs in healthcare systems.

Methods: A simulation model was constructed using data from an observational study in a clinical setting. PHI values were used to determine biopsy decisions in a simulated population of 10,000 men aged 50-70 with PSA levels 3-10 ng/mL. Logistic regression modeled the correlation between PHI and clinically significant PCa (csPCa). Three csPCa prevalence scenarios (10%, 20%, and 30%) were tested to assess cost-minimizing effects. Decision trees compared the PHI-guided biopsy approach to the conventional PSA-based strategy.

Results: The PHI-guided approach reduced up to 49.7% negative and low-grade biopsies and demonstrated cost savings compared to the conventional PSA-based strategy. Use of PHI resulted in cost savings of €233 per patient in csPCa detection. The mean cost of the PHI pathway was €681, compared to €915 for the conventional PSA-based pathway. However, the study's reliance on synthetic data and the limited inclusion of MRI in the dataset may affect the generalizability of findings.

Conclusions: Incorporating PHI into PCa screening could reduce overdiagnosis, unnecessary biopsies, and overall healthcare costs. Further prospective studies are needed to confirm PHI's role as a cost-effective reflex test and its integration into broader PCa screening strategies.

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来源期刊
World Journal of Urology
World Journal of Urology 医学-泌尿学与肾脏学
CiteScore
6.80
自引率
8.80%
发文量
317
审稿时长
4-8 weeks
期刊介绍: The WORLD JOURNAL OF UROLOGY conveys regularly the essential results of urological research and their practical and clinical relevance to a broad audience of urologists in research and clinical practice. In order to guarantee a balanced program, articles are published to reflect the developments in all fields of urology on an internationally advanced level. Each issue treats a main topic in review articles of invited international experts. Free papers are unrelated articles to the main topic.
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