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This study assessed the cost\u2010effectiveness of 10 screening strategies: prostate\u2010specific antigen\u2010based risk\u2010adaptive screening (PSA\u2010RAS), 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\u201375\u2009years, 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\u2010years, and quality\u2010adjusted life\u2010years (QALYs) discounted annually at 3%. Cost and utility inputs were derived from the German diagnostic\u2010related group schedule, fee\u2010for\u2010service catalogues, literature, and expert opinion. DRE\u2010only was the least cost\u2010effective, yielding high biopsy and overdiagnosis rates with minimal QALY gains. PSA\u2010RAS reduced overdiagnosis and biopsy rates, with PSA\u2010RAS (50\u201360\u2009years) without MRI emerging as the most cost\u2010efficient strategy, saving approximately \u20ac1.2 million per 100,000 men compared with no screening. Extending the PSA\u2010RAS to 70\u2009years improved its effectiveness in terms of QALYs. PSA\u2010RAS (50\u201370) with MRI could become cost\u2010effective at an increasing willingness to pay threshold or decreasing MRI cost. This study suggests the potential of PSA\u2010RAS 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\u2010effectiveness of PSA\u2010RAS with MRI. Future research should explore the integration of MRI with ancillary tests, such as 4K\u2010score or risk calculators, to reduce MRI use and associated costs.<\/jats:p>","DOI":"10.1002\/ijc.35513","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T03:50:33Z","timestamp":1752724233000},"page":"1662-1679","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Cost effectiveness analysis of prostate cancer screening strategies in Germany: A microsimulation study"],"prefix":"10.1002","volume":"157","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8918-8673","authenticated-orcid":false,"given":"Muchandifunga Trust","family":"Muchadeyi","sequence":"first","affiliation":[{"name":"Division of Health Economics German Cancer Research Centre (DKFZ)  Heidelberg Germany"},{"name":"Medical Faculty Mannheim University of Heidelberg  Mannheim Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2303-4532","authenticated-orcid":false,"given":"Shuang","family":"Hao","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6685-1903","authenticated-orcid":false,"given":"Karla","family":"Hernandez\u2010Villafuerte","sequence":"additional","affiliation":[{"name":"Division of Health Economics German Cancer Research Centre (DKFZ)  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5121-8630","authenticated-orcid":false,"given":"Shah Alam","family":"Khan","sequence":"additional","affiliation":[{"name":"Division of Health Economics German Cancer Research Centre (DKFZ)  Heidelberg Germany"},{"name":"Medical Faculty Mannheim University of Heidelberg  Mannheim Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3230-4223","authenticated-orcid":false,"given":"Nikolaus","family":"Becker","sequence":"additional","affiliation":[{"name":"Division of Personalized Early Detection of Prostate Cancer German Cancer Research Centre (DKFZ)  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8192-9759","authenticated-orcid":false,"given":"Agne","family":"Krilaviciute","sequence":"additional","affiliation":[{"name":"Division of Personalized Early Detection of Prostate Cancer German Cancer Research Centre (DKFZ)  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra","family":"Seibold","sequence":"additional","affiliation":[{"name":"Division of Personalized Early Detection of Prostate Cancer German Cancer Research Centre (DKFZ)  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7592-6567","authenticated-orcid":false,"given":"Roman","family":"Gulati","sequence":"additional","affiliation":[{"name":"Division of Public Health Sciences Fred Hutchinson Cancer Center  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7360-6335","authenticated-orcid":false,"given":"Peter","family":"Albers","sequence":"additional","affiliation":[{"name":"Division of Personalized Early Detection of Prostate Cancer German Cancer Research Centre (DKFZ)  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3489-5856","authenticated-orcid":false,"given":"Michael","family":"Schlander","sequence":"additional","affiliation":[{"name":"Division of Health Economics German Cancer Research Centre (DKFZ)  Heidelberg Germany"},{"name":"Medical Faculty Mannheim University of Heidelberg  Mannheim Germany"},{"name":"Alfred Weber Institute for Economics (AWI) University of Heidelberg  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4518-5670","authenticated-orcid":false,"given":"Mark","family":"Clements","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,16]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"German Centre for Cancer Registry Data.Prostate cancer. 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