A microsimulation study conducted by researchers from the University of Hong Kong (HKU), Guangzhou Medical University, and Shanghai Jiao Tong University shows that prostate-specific antigen (PSA) screening would be highly cost-effective and significantly improve survival outcomes for patients with prostate cancer in China.
Currently, PSA screening coverage varies significantly across countries, as its cost-effectiveness remains a topic of debate. Previous cost-effectiveness analyses examined PSA screening mainly in Western populations. [J Natl Cancer Inst 2014;107:366] To date, no evidence has been reported regarding its cost-effectiveness in China or other middle-income countries. At present, there is no official national PSA screening programme in China.
“In this study, we aimed to comprehensively evaluate the efficacy and cost-effectiveness of PSA screening with multiple screening strategies in China,” wrote the researchers. “We constructed a dynamic Markov microsimulation model, incorporating the anticipated population ageing pattern in the coming years [and fully evaluating] the heterogeneic socioeconomic factors from different regions in China.” [Lancet Reg Health West Pac 2025;doi:10.1016/j.lanwpc.2025.101683]
The model assessed 56 conventional population-wide PSA screening strategies based on data from a 5-year trial with 104,751 participants, a 20-year multicentre database, and parameters collected across China. All of the evaluated strategies led to gain in quality-adjusted life years (QALYs) and were considered cost-effective under a willingness-to-pay threshold equal to China’s per capita GDP (USD 12,510.12 per QALY). This threshold was derived from the 2023 GDP per capita of economically diverse provinces and municipalities, representing varying income levels across China.
“From a health economics perspective, if a medical intervention is proven to be ‘cost-effective’ in regions with lower GDP per capita, its feasibility and economic benefits are even more significant in a high-income economy, like Hong Kong,” said one of the study authors, Dr Rong Na of the Department of Surgery, HKU. “With more abundant medical resources and higher purchasing power, Hong Kong is well-positioned to implement proactive early screening to reduce the societal burden of advanced cancer.”
The most intensive protocol, which involved annual screening of men aged 45–74 years using age-specific cut-offs, had an incremental cost-effectiveness ratio (ICER) of USD 5,535.25 per QALY, yielding 2.79 incremental QALYs vs not screening. Furthermore, compared with not screening, this strategy would reduce the metastasis-incidence ratio (ie, proportion of metastatic cases at first diagnosis) from 39.05 to 1.04 percent, while case fatality rate would reduce from 6.14 to 2.85 percent.
If implemented, screening would reduce the rate of metastatic presentation, thus shifting the harm–benefit balance of a whole population–based screening strategy. To address this, the researchers evaluated the cost-effectiveness of two genetic testing strategies, namely, targeted genotyping for polygenic risk scores (PRS) and whole-genome sequencing (WGS), which could be used to de-intensify screening. Results showed that a one-time targeted genotyping for PRS would offer QALYs and ICERs comparable to population-wide PSA screening, while enabling 66.8 percent of average-risk males to postpone their screening starting age or prolong their screening interval. On the other hand, a one-time WGS did not improve cost-effectiveness as it yielded similar QALYs but higher ICERs vs universal screening.
“We hope this health economics study, which combines clinical data from Hong Kong and Chinese Mainland, will promote a review of prostate cancer screening guidelines in the city. In the long term, this will help achieve ‘early detection – early treatment’, improve men’s life expectancy in Hong Kong, and alleviate societal and medical costs,” concluded Na.
