What do you think should be done moving forward in this research area?
–There is a lot to be done moving forward. As the Organised Prostate Cancer Testing (OPT) projects have started or is being planned in 17 out of 21 regions in Sweden, assessing the cost-effectiveness for different regional projects and for OPT at a national level is critical before a future national screening program can be formed. To realise this, a research project needs to do several things; firstly, to model for the opportunistic screening which reflects the current testing situation in Stockholm/Sweden; secondly to extend our microsimulation model by including the measure of PSA density in the base algorithm of OPT. Thirdly, we need to incorporate the evidence regarding the subsequent rescreening results from the STHLM3-MRI Reinvite trial; and finally to recalibrate the model. Once these things are achieved, we hope to provide solid evidence on the cost-effectiveness of OPT to the policy makers to make informed decision-making.
Other considerations
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–In addition, although MRI has been recommended by the national treatment guidelines and by the OPT protocol, one should note that there may still be limited access to MRI in some regions that have less health resources. An investigation has been conducted to understand if using the Stockholm3 test and the systematic biopsy can be an alternative in these areas to address the access issue with MRI and the combined targeted and systematic biopsy. A cost-effectiveness analysis comparing these two testing strategies would be necessary to support the decision making.
Other novel technologies currently under investigation may become important components in future testing or care pathways. The artificial-intelligence assisted pathology in aiding the prediction of the risk levels for the prostate cancer patients may reduce resource utilization, time and costs. Assigning related therapies to patients with target signatures from the sequencing is anticipated to improve the survival and quality of life of the metastatic prostate cancer patients. Cost-effectiveness analyses examining the health consequences and costs for these technologies are therefore very important.
Measuring the health state values along the prostate cancer diagnosis and care pathways using the same health outcome instrument is also of great priority. This could systematically reflect the patient-reported outcomes and provide more valid input to future economic evaluations.
