Cost-benefit analysis of a population-based prostate-specific antigen mass testing for early detection of prostate cancer in Anambra State, Nigeria: A health provider's perspective

Aims: We conducted a cost-benefit analysis of a population-based prostate-specific antigen (PSA) mass testing for prostate cancer (PCa) from a provider's perspective to give further insights into the programme's sustainability at scale-up. Materials and Methods: A cross-sectional study design was adopted. The cost and benefit of the population-based-specific antigen mass testing were estimated using activity-based costing and participants' willingness to pay (WTP), respectively. The study was conducted in a primary health-care facility in Anambra State, Nigeria. A total of 412 asymptomatic males between 40 and 74 years who had not had a PSA screening within the past five years were recruited for the study. A one-month population-based PSA mass screening for PCa was performed at the primary health-care facility. The cost of population-based PSA mass testing was presented as cost/male screened while benefit was measured as the participants' minimum WTP analysis amount. Benefit-cost ratio (BCR) served as the primary outcome, with values higher than one signifying a self-sustainable programme. Results: The cost/male screened was USD 13.43 ± 2.26, while the participants' WTP amount of US$3.99 ± 4.49 to calculate the BCR gave a BCR ratio of 0.3. Conclusion: The estimated BCR showed that the programme would not be sustainable if funding were based solely on participants' out-of-pocket expenses. Other financing mechanisms, such as donor funds, will be necessary to sustain such public health programmes in Nigeria.