A Cost-Utility Analysis of Prostate Cancer Screening in Australia

Background and Objectives: The Göteborg randomised population-based prostate cancer screening trial demonstrated that Prostate Specific Antigen (PSA) based screening reduces prostate cancer deaths compared with an age matched control group. Utilising the prostate cancer detection rates from this study we have investigated the clinical and cost-effectiveness of a similar PSA-based screening strategy for an Australian population of men aged 50-69 years. Methods: A decision model that incorporated Markov processes was developed from a health system perspective.The base case scenario compared a population-based screening programme with current opportunistic screening practices. Costs, utility values, treatment patterns and background mortality rates were derived from Australian data. All costs were adjusted to reflect July 2015 Australian dollars. An alternative scenario compared systematic with opportunistic screening but with optimisation of active surveillance (AS) uptake in both groups. A discount rate of 5% for costs and benefits was utilised. Univariate and probabilistic sensitivity analyses were performed to assess the effect of variable uncertainty on model outcomes. Results: Our model very closely replicated the number of deaths from both prostate cancer and background mortality in the Göteborg study. The incremental cost per quality-adjusted life-year (QALY) for PSA screening was $AU147,528. However, for years of life gained (LYGs) PSA based screening ($AU45,890/LYG) appeared more favourable. Our alternative scenario with optimised AS improved cost-utility to $AU45,881/QALY, with screening becoming cost-effective at a 92$AU50,000/QALY. It appears more cost-effective if LYGs are used as the relevant outcome, and is more cost effective than the established Australian breast cancer screening programme on this basis. Optimised utilisation of AS increases the cost-effectiveness of prostate cancer screening dramatically

XANES calibration for determining the oxidation state of iron in mantle garnet.

Iron K-edge X-ray absorption near edge structure (XANES) spectra were recorded for synthetic garnets of the almandine–skiagite (Fe3Al2Si3O12–Fe3Fe2Si3O12), andradite–skiagite (Ca3Fe2Si3O12–Fe3Fe2Si3O12), Fe–knorringite–skiagite (Fe3Cr2Si3O12–Fe3Fe2Si3O12), and andradite–grossular (Ca3Fe2Si3O12–Ca3Al2Si3O12) solid solutions. Fe3+/ΣFe varied systematically in these samples from 0 to 1. The variation in the energy and intensity of spectral features as a function of Fe3+/ΣFe was investigated to identify correlations that could be used to determine Fe3+/ΣFe of unknowns. The pre-edge energy, which is commonly used for quantification, was found to be relatively insensitive for garnet, particularly at low values of Fe3+/ΣFe. The best correlation was for the absorption edge energy, which may provide an accurate and precise method for determining Fe3+/ΣFe of garnets in metapelitic rocks. The resulting calibration curve, however, significantly and non-systematically overestimates the Fe3+/ΣFe value of mantle garnets (from xenoliths and megacrysts) for which Fe3+/ΣFe had been determined previously by Mössbauer spectroscopy. This is probably a result of differences in composition between the synthetic and natural garnets. For the mantle garnets, Fe3+/ΣFe is strongly correlated with the intensity ratio of post-edge features at 7138.4 and 7161.7 eV. The deviation of the Mössbauer results from a linear fit is less than 0.01 (1 σ). This suggests a new method for determining Fe3+/ΣFe from XANES spectra that does not require precise energy calibration or spectral fitting. The accuracy and precision for mantle garnets (within the compositional range studied: 0.75 ≤ Mg/(Mg + Fe) ≤ 0.86, 3.7–6.3 wt.% CaO, and 0.3–7.4 wt.% Cr2O3) is comparable to those of Mössbauer spectrosopy, however, XANES spectra can be acquired in ~ 15 min, allowing large numbers of samples to be analysed or the distribution of Fe3+/ΣFe to be mapped with micron spatial resolution. © 2010, Elsevier Ltd

Relationships between oxygen fugacity and metasomatism in the Kaapvaal subcratonic mantle, represented by garnet peridotite xenoliths in the Wesselton kimberlite, South Africa

A suite of 12 peridotite xenoliths from the Wesselton kimberlite was studied and found to sample the subcratonic lithospheric mantle over a pressure range from 3.6 to 4.7 GPa and a temperature range of 880 to 1120 °C. Major, minor and trace element compositions indicate that both metasomatised and un-metasomatised samples are present over this pressure range. Fe3 +/∑ Fe in garnet from four xenoliths was determined using Fe K-edge XANES spectroscopy, enabling the redox state of the sampled subcratonic mantle to be determined for three garnet bearing samples. ΔlogfO2[FMQ] varied from 0 to − 3.3 over the sampled pressure interval, with the un-metasomatised samples falling within the global trend of decreasing ΔlogfO2[FMQ] with increasing depth. Superimposed on this was an oxidation trend, at higher pressures (≥ 4.5 GPa), with ΔlogfO2 increasing by 1.5 to 2 units in the metasomatically enriched samples, indicating a clear link between metasomatism and oxidation. One potential source of this oxidation is a carbonated silicate melt, which will increase in carbonate content as ΔlogfO2 increases. Mantle minerals affected by such a melt have the potential to shift from the field of diamond stability into that of carbonate, threatening the stability of diamond

Fluxing of mantle carbon as a physical agent for metallogenic fertilization of the crust

Magmatic systems play a crucial role in enriching the crust with volatiles and elements that reside primarily within the Earth’s mantle, including economically important metals like nickel, copper and platinum-group elements. However, transport of these metals within silicate magmas primarily occurs within dense sulfide liquids, which tend to coalesce, settle and not be efficiently transported in ascending magmas. Here we show textural observations, backed up with carbon and oxygen isotope data, which indicate an intimate association between mantle-derived carbonates and sulfides in some mafic-ultramafic magmatic systems emplaced at the base of the continental crust. We propose that carbon, as a buoyant supercritical CO2 fluid, might be a covert agent aiding and promoting the physical transport of sulfides across the mantle-crust transition. This may be a common but cryptic mechanism that facilitates cycling of volatiles and metals from the mantle to the lower-to-mid continental crust, which leaves little footprint behind by the time magmas reach the Earth’s surface.NERC Minerals Security of Supply (SOS) NE/M010848/1Australian Research Council CE11E0070Consolidated Nickel MinesUniversity of Leiceste