A Cost-Analysis and Micro-Costing Study of the Man Van Project: Comparing Prostate-Specific Antigen Testing Via a Nurse-Led Mobile Service with Primary Care - Beyond the Abstract
Why This Study Matters
Early detection of prostate cancer remains an important clinical goal, yet participation in PSA testing is often influenced by barriers, including access to primary care, appointment availability, travel requirements, and health literacy. Traditional primary care models may not sufficiently reach populations who are underserved or less likely to engage in preventive services.
Mobile health initiatives, such as the Man Van Project, aim to address these disparities by bringing screening services directly into communities. However, implementation of such services requires a robust economic evaluation to determine sustainability and potential integration into health systems.
Methodological Considerations
Our study applied micro-costing techniques to capture the true operational costs of delivering PSA testing via a nurse-led mobile unit. This approach allowed detailed evaluation of staffing, equipment, consumables, logistics, and overhead costs associated with mobile deployment.
Importantly, our evaluation considered real-world service delivery, rather than theoretical modeling, capturing practical aspects such as staffing efficiency, patient throughput, and outreach logistics.
Key Insights
The mobile service model demonstrated the ability to deliver PSA testing efficiently while expanding access to populations less likely to attend traditional healthcare settings. While direct costs per test may differ compared with primary care, mobile delivery offers value in terms of accessibility, convenience, and potential early detection in communities where engagement is otherwise limited.
Furthermore, nurse-led service delivery highlights opportunities for task-shifting and workforce optimisation, potentially alleviating pressures on primary care providers while maintaining high-quality screening services.
Broader Implications
Beyond cost considerations, mobile screening programs may influence public awareness, health engagement, and equity in prostate cancer detection. These programs can function as both diagnostic and educational interventions, encouraging men to engage with healthcare services they might otherwise avoid.
Health systems increasingly recognize that cost-efficiency must be balanced with access and public health impact. Programs like the Man Van Project provide a model for reaching high-risk or underserved populations in ways traditional services may not.
Limitations and Future Directions
Our analysis focused primarily on service delivery costs and did not directly evaluate long-term clinical outcomes such as earlier cancer detection rates or downstream treatment cost savings. Future studies should explore patient outcomes, follow-up adherence, and overall health system impact.
Additionally, scalability and sustainability of mobile programs require further evaluation, including assessment of regional deployment strategies and integration with primary care and specialist referral pathways.
Conclusion
This study demonstrates that nurse-led mobile PSA testing services represent a viable alternative approach to traditional screening delivery, with potential benefits in accessibility and community engagement. As health systems continue to pursue strategies that balance cost, efficiency, and equity, mobile health initiatives deserve careful consideration within prostate cancer screening strategies.
Written by: Masood Moghul, FRCS (Urol), PhD, Consultant Urologist, Department of Urology, The Royal Marsden NHS Foundation Trust; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK.
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