Abstract / Summary
To evaluate the cost-effectiveness of integrating the Prostate Health Index (PHI) into prostate cancer (PCa) screening and diagnostic pathway in China, and to explore the impacts of varying screening initiation ages, intervals, and PHI cutoffs. A Markov microsimulation model was developed to compare two strategies: (1) Prostate Specific Antigen (PSA) strategy: Magnetic Resonance Imaging (MRI) for PSA 4–10 ng/mL, then biopsy for Prostate Imaging Reporting and Data System (PI-RADS) ≥ 3; (2) PHI strategy: PHI testing for PSA 4–10 ng/mL, followed by MRI for PHI > cutoff, and then biopsy for PI-RADS ≥ 3. Sensitivity analyses were performed. Compared with the PSA strategy, PHI strategy (initiation age 50, biennial, PHI cutoff of 35) reduced diagnostic costs by $643,398 (30.1%) and total costs by $1,115,276 (6.4%), while decreasing unnecessary biopsies by 1,815 (62.9%) and QALYs by 32 but increasing missed cases of csPCa by 6 and deaths by 8 per 10,000 men. The incremental cost-utility ratio (ICUR) was $34,852/QALY. Higher screening initiation ages, longer intervals, or higher PHI cutoffs reduced costs and unnecessary biopsies, increased missed diagnoses of csPCa, deaths, and a loss of health utility. Among the secondary analyses, initiation at age 50 with a 4-year screening interval showed favorable cost-effectiveness among the evaluated age/interval scenarios, while a PHI cutoff of 35 showed favorable cost-effectiveness in the cutoff analysis. The PHI strategy demonstrates favorable cost-effectiveness, with age 50 initiation, quadrennial screening, and a PHI cutoff of 35 showing favorable results. Not applicable.