The costs of identifying undiagnosed prostate cancer in asymptomatic men in New Zealand general practice

Transcription

1 The costs of identifying undiagnosed prostate cancer in asymptomatic men in New Zealand general practice Chunhuan Lao, Charis Brown, Zuzana Obertová, Richard Edlin, Paul Rouse, Fraser Hodgson, Michael Holmes, Ross Lawrenson RNZCGP Conference 13 July 2013

2 Introduction Methods Results Discussion Conclusion

3 Introduction Prostate cancer (PCa) screening Not recommended [1] 345, 000 prostate specific antigen (PSA) tests in 2010 [2] 80% PSA tests on asymptomatic men [3] [4] 1

4 Introduction Objective estimates the costs of identifying a new case of PCa by different age groups ethnicity former PSA testing history 2

5 Materials Eligible subjects male patients aged 40+ had no previous history of PCa underwent one or more PSA tests in 31 general practices in Midland region in 2010 Data recorded age ethnicity previous PSA testing histories PSA tests referrals to specialists biopsies 3

6 Methods A Decision Tree was constructed to: map the screening pathway document the costs associated with each node An aggregate cost The quantity of healthcare resources the unit cost of each type of resource 4

7 Costs of follow up general practitioner consultations and PSA tests Costs of the first specialist assessments, follow up specialist consultations and PSA tests Costs of biopsies, pathology reports, hospitalization (complications caused by biopsy), follow-up specialist consultations Costs of PSA tests Costs of initial general practitioner consultations for PSA testing Figure 1. Pathway of screening for PCa in New Zealand 6

8 Methods Initial GP consultation The time spent on discussion about PSA testing ranges from almost no time (ticking the box of a laboratory form) the whole consultation 80% of PSA tests were general practitioner initiated only 20% were patient initiated [3] [4] 20% of the cost of initial GP consultation was attributed to PSA testing 6

9 Methods Table 1. The unit costs of medical resources Medical resources Corrected cost in 2010 PSA test $11.07 GP consultation $73.54 GP charge $35.88 subsidy $37.66 First specialist assessment $ Follow-up specialist consultation $ Biopsy $ Pathology report of biopsy $ Hospitalization after biopsy (per bed day) $ * All the unit costs were based on public hospitals 7

10 Results Table 2. Number of PCa and men screened per PCa identified Categories PCa identified Men screened per cancer identified Age group Ethnicity Māori Non-Māori PSA testing history No PSA tests in Had PSA tests in Overall

11 Results Table 3. Quantity of medical resources for PCa Screening Categories Quantity PSA test ordered by GP 8133 Initial GP consultation 7936 Follow up GP consultation 197 FSA 69 Follow-up specialist consultation 78 PSA test ordered by specialist 32 Biopsy 46 Pathology report 46 Hospitalization after biopsy (bed days)

12 Results Table 3. Costs per cancer identified $30,000 $26,877 $25,000 $20,000 $16,814 $15,000 $10,000 $10,777 $5,000 $0 20% of initial GP consultation cost included 50% of initial GP consultation cost included 100% of initial GP consultation cost included 10

13 11 Results Table 4. Costs per cancer identified by age groups $35,000 $30,000 $30,022 $25,000 $24,290 $20,000 $15,000 $10,000 $5,000 $6,268 $10,957 $ yrs yrs yrs 70 yrs

14 12 Results Table 4. Costs per cancer identified by ethnicity $12,000 $11,272 $10,000 $8,000 $7,685 $6,000 $4,000 $2,000 $0 Māori Non-Māori

15 13 Results Table 4. Costs per cancer identified by ethnicity $16,000 $14,000 $13,870 $12,000 $10,000 $8,887 $8,000 $6,000 $4,000 $2,000 $0 No PSA tests in Had PSA tests in

16 Figure 2. Proportion of the cost of each type of medical resources in total cost 14

17 Discussion 1. The costs of identifying a new case of PCa in asymptomatic men were NZ$10, Over 40% of the costs was GP time (3 minutes per man screened) in informed consent 3. If all men received informed consent (15 minutes per man screened), the costs per cancer detected were more than double (NZ$26,877) 4. The most cost-effective screening was for men aged 60-69, Maori men without screening history in the last 3 years 15

18 Conclusion Most of the estimated costs of screening were estimated in general practice Calls for men to receive increased information on the harms and benefits of screening will substantially increase the costs per cancer identified The costs could be reduced by better targeting of screening 16

19 Reference 1. New Zealand Guidelines Group, Testing for Prostate Cancer, 2008: Wellington, New Zealand. 2. Ministry of Health, Unpublished data from the Ministry of Health, 2012: Wellington, New Zealand. 3. Ministry of Health, A portrait of health: key results of the 2006/07 New Zealand Health Survey, 2008: Wellington, New Zealand. 4. Hodgson F, Obertová Z, Brown C, Lawrenson R. PSA testing in general practice. Journal of Primary Health Care. 2012;4(3):

20 Funding: Health Research Council of New Zealand (HRC Partnership Programme grant number 11/082, entitled The costs and complications of screening for prostate cancer ). Chunhuan Lao has been provided with a scholarship by the New Zealand Ministry of Health. 18

21 THANK YOU