COMMENT

摘要

The study by Heijnsdijk et al makes an important contribution to our understanding of whether PSA screening is likely to offer a health benefit. The key finding of the study is that PSA screening offers a more modest benefit when quality of life is accounted for: 56 QALYs gained compared with 73 life-years gained. But, there is still a positive benefit from PSA screening, and the adverse effects of over-diagnosis and over-treatment do not outweigh the survival benefit. The authors go "to great lengths" to present their results in the correct light. They spend time discussing the assumptions used in modeling and, in particular, the issue that changes in utility estimates for different health states can change model results significantly. This, however, is a problem for most QALY-based microsimulation models they tend to be sensitive to changes to utility estimates.