Evidence map›Paper›PMID 41018944›Full record

ArticleThe Lancet regional health. Western Pacific2025

Cost-effectiveness analysis of prostate-specific antigen screening in China: a middle-income population-based microsimulation study.

Jiacheng Liu, Yuanshi Jiao, Yueting Huang, Yongle Zhan, Ruofan Shi, Xiaohao Ruan, Chi Yao, Ruochen Ma, Salida Ali, Tsun Tsun Chun and 6 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet regional health. Western Pacific, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Jiacheng LiuDepartment of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Yuanshi JiaoDepartment of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China.
Yueting HuangGuangdong Provincial Key Laboratory of Urological Diseases, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Yongle ZhanDepartment of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China.
Ruofan ShiDepartment of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Xiaohao RuanDepartment of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Chi YaoDepartment of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China.
Ruochen MaDepartment of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China.
Salida AliDepartment of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China.
Tsun Tsun ChunDepartment of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China.
Da HuangDepartment of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Danfeng XuDepartment of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Qian ZhangDepartment of Urology, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China.
Di GuGuangdong Provincial Key Laboratory of Urological Diseases, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Xue LiDepartment of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China.
Rong NaDepartment of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: The significance of prostate-specific antigen (PSA) in reducing the health burden of prostate cancer is widely deliberated. We conducted this study, utilising real-world data, to develop a comprehensive, cost-effectiveness analysis model for PSA screening. By evaluating various screening strategies, we aim to provide policymakers with robust research evidence to inform future PSA screening policies. Methods: We constructed a microsimulation model to assess 56 conventional population-wide PSA screening strategies based on data from a five-year trial with 104,751 participants, a 20-year multicentre database and parameters collected across China, along with approaches involving genetic risk stratification based on family history, polygenic risk scores, and high-penetrance genes. Clinical outcomes including incidence, metastasis-incidence ratio (M/I ratio), and annual case-fatality rate (CFR) were evaluated. Cost-effectiveness was evaluated using incremental quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). Sensitivity and scenario analyses were conducted to test the robustness of the results. Findings: All strategies led to QALY gains and were considered cost-effective under a willingness-to-pay threshold equal to China's per capita GDP ($12,510.12 per QALY). The most intensive protocol (45-74 years, annually, with age-specific PSA cutoffs) had an ICER of 5535.25USD/QALY, yielding 2.79 incremental QALYs compared to non-screening, reducing M/I ratio from 39.05% to 1.04%, and CFR from 6.14% to 2.85%. The genetic risk-specific protocol offered comparable QALYs (2.79 vs. 2.76) and ICERs (5287.23 vs. 4904.90USD/QALY), allowing for 66.8% of average-risk individuals with extended screening intervals or postponed screening start age. Interpretation: PSA screening in China has the potential to improve overall health outcomes in a cost-effective manner. Personalised screening based on genetic risk may provide an efficient alternative to uniform strategies, potentially reducing unnecessary interventions among those at lower risk. This study provides a solid evidence base for Chinese policymakers to consider establishing a cost-effective, risk-stratified PCa screening programme. Funding: Shenzhen-Hong Kong-Macau S&T Programme, HKU Seed Fund, RJH Cultivating Star Programme, HK UGC Research Impact Fund and Guangdong High-Level Talents Programme.

Indexed as

Cost-effectiveness analysisEarly detectionMiddle-income countriesPolygenic risk scoreProstate cancerProstate-specific antigenRisk assessmentScreening

Identifiers

PMID41018944
PMCPMC12465055

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.