: The five screening strategies were reported clearly. The cut-off baseline PSA values for the four personalised re-screening strategies were well described. However, the authors acknowledged that these values were only based on one study report. It would appear that annual PSA was current practice in the authors’ setting.
: The effectiveness data were derived from various sources. The methods of the literature review were not reported, which makes it impossible to ascertain whether the best available evidence was used to inform the model. However, the authors justified only using one study for deriving PSA distributions and probabilities of PSA elevation on the basis of there being few published works in the field. There was no information about the derivation of the utilities used to compute the QALYs, and the authors highlighted the fact that the QALY results presented may not be robust. This leaves some uncertainty regarding the validity of the effectiveness estimates used.
: Although a societal perspective was stated, in fact, a health care perspective was undertaken given that wider societal costs were not taken into account. The authors justified this limitation by the lack of data. The cost categories and unit costs were well reported and discounting was appropriate, but the level of resource use and the price year were not stated. Therefore, the costs were poorly reported.
Results and Analysis:
: An appropriate incremental analysis was conducted and the results were presented in full. The model structure was described in full detail, including a graphical depiction, which aids transparency. In addition, the methods used throughout the economic evaluation and the sensitivity analysis were well reported. The results were robust to changes in all input parameters in the one-way sensitivity analysis. However, a probabilistic sensitivity analysis would have been a more complete way to fully capture parameter uncertainty. The authors acknowledged that the cut-off baseline PSA levels for annual PSA testing can be changed according to age and gender of the population under analysis. They also noted the need for randomised controlled trials to show a mortality benefit from PSA screening. A number of other possible limitations and their potential impact on the results were outlined.
: Overall, the methodology of the study appears to have been appropriate and was well reported. However, there were a few limitations to the study, so the authors' conclusions should be considered with a degree of caution.