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@ARTICLE{Muchadeyi:303022,
      author       = {M. Muchadeyi$^*$ and S. Hao and K. V. Hernandez
                      Villafuerte$^*$ and S. A. Khan$^*$ and N. Becker$^*$ and A.
                      Krilaviciute$^*$ and P. Seibold$^*$ and R. Gulati and P.
                      Albers$^*$ and M. Schlander$^*$ and M. Clements},
      title        = {{C}ost effectiveness analysis of prostate cancer screening
                      strategies in {G}ermany: {A} microsimulation study.},
      journal      = {Radiation oncology investigations},
      volume       = {157},
      number       = {8},
      issn         = {1065-7541},
      address      = {New York, NY},
      publisher    = {Wiley Interscience},
      reportid     = {DKFZ-2025-01469},
      pages        = {1662-1679},
      year         = {2025},
      note         = {#EA:C100# / 2025 Oct 15;157(8):1662-1679},
      abstract     = {Prostate cancer (PCa) represents a significant public
                      health challenge in Germany, with increasing incidence and
                      economic impact. This study assessed the cost-effectiveness
                      of 10 screening strategies: prostate-specific antigen-based
                      risk-adaptive screening (PSA-RAS), with or without magnetic
                      resonance imaging (MRI), in men starting at age 45 or 50 and
                      stopping at 60 or 70, digital rectal examination (DRE) for
                      ages 45-75 years, and no screening. Using a well calibrated
                      microsimulation model (Swedish Prostata) from a statutory
                      health insurance perspective, lifetime outcomes were
                      evaluated, including cancer incidence, mortality,
                      overdiagnosis, biopsies, life-years, and quality-adjusted
                      life-years (QALYs) discounted annually at $3\%.$ Cost and
                      utility inputs were derived from the German
                      diagnostic-related group schedule, fee-for-service
                      catalogues, literature, and expert opinion. DRE-only was the
                      least cost-effective, yielding high biopsy and overdiagnosis
                      rates with minimal QALY gains. PSA-RAS reduced overdiagnosis
                      and biopsy rates, with PSA-RAS (50-60 years) without MRI
                      emerging as the most cost-efficient strategy, saving
                      approximately €1.2 million per 100,000 men compared with
                      no screening. Extending the PSA-RAS to 70 years improved its
                      effectiveness in terms of QALYs. PSA-RAS (50-70) with MRI
                      could become cost-effective at an increasing willingness to
                      pay threshold or decreasing MRI cost. This study suggests
                      the potential of PSA-RAS to improve PCa screening in
                      Germany. Incorporating MRI, reducing MRI cost within the
                      screening setting, and extending screening to 70 to align
                      with EU recommendations could improve the cost-effectiveness
                      of PSA-RAS with MRI. Future research should explore the
                      integration of MRI with ancillary tests, such as 4K-score or
                      risk calculators, to reduce MRI use and associated costs.},
      keywords     = {QALYs (Other) / cost‐effectiveness analysis (Other) /
                      magnetic resonance imaging (Other) / organised screening
                      (Other) / prostate cancer (Other) / prostate‐specific
                      antigen (Other)},
      cin          = {C100 / C130},
      ddc          = {610},
      cid          = {I:(DE-He78)C100-20160331 / I:(DE-He78)C130-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40665795},
      doi          = {10.1002/ijc.35513},
      url          = {https://inrepo02.dkfz.de/record/303022},
}