By Gabriel Miller

NEW YORK (Reuters Health) May 16 - The cost of knowing a man's prostate specific antigen (PSA) level is rarely limited to lab and biopsy expenses, according to a presentation yesterday at the 2011 meeting of the American Urological Association in Washington, D.C.

Compared to men who do not undergo PSA testing, those who do -- even those with normal results -- experience a "cascade of events" that can have serious economic and clinical effects.

"The take away message," said Dr. Steve Zeliadt, a public health researcher at the University of Washington in Seattle, "is that PSA testing results in additional costs that far exceed the $45 lab test."

"Men should be aware that once (they) start testing, they may potentially enter into a cascade of repeat visits (and) additional tests and procedures," he told Reuters Health.

As he reported at the meeting, Dr. Zeliadt and his colleagues used the Ingenix LabRx database of health insurer United Healthcare to match more than 48,000 men who had PSA testing between 2004-2005 with nearly 145,000 men who had at least one primary care visit but no PSA tests during the same period.

The men were matched on demographic and clinical characteristics, including their health care utilization patterns in the prior year. Roughly two-thirds in each group were under age 55.

Healthcare costs were then tallied for each group. Charges for patients who developed prostate cancer were stopped at the time of cancer diagnosis so that only non-cancer costs were measured.

To make sure that benign conditions like prostatitis and benign prostatic hyperplasia were not contributing to costs, the investigators adjusted the analysis to make sure that the rates of these other conditions were similar across the groups.

In the year prior to PSA testing, all patients had identical health plan charges, however after PSA testing there were substantial differences unrelated to cancer treatment. As a baseline measure, men with low PSA values (<2.5 ng/mL) had an average of $19,313 in health-care charges. Comparatively, charges were $4,087 higher for men with PSA 2.5-3.9 ng/mL and $4,725 higher for men with PSA >4.0 ng/mL.

Charges were $1,519 lower for men with no PSA test.

Overall, prostate cancer was diagnosed in 0.7% of men with PSA <2.5 ng/mL, 4.1% of men with PSA 2.5-3.9 ng/mL, and 22.3% of men with PSA >4.0 ng/mL.

From an economic point of view, when policy makers ask an insurer to pay for a PSA test "they are not really considering what happens after the test is performed," said Dr. David Penson, a urologic surgeon and director of the Center for Surgical Quality & Outcomes Research at Vanderbilt University Medical Center in Nashville.

In truth, a $45 PSA test may actually lead to $1500 in costs, the study shows. The extra costs generally occur as a result of increased urology office visits, and pelvic imaging procedures and biopsies, said Dr. Zeliadt.

This flood of events -- with economic and clinical costs, and potential biopsy-related complications -- also has implications for individual patients, said Dr. Penson, who was not involved in Dr. Zeliadt's research.

"This is another piece in a pretty complete puzzle that shows that a PSA test is not just a benign blood test," Dr. Penson said to Reuters Health. "It's not done in isolation."


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