An Economic Analysis of Conservative Management Versus Active Treatment for Men with Localized Prostate Cancer

Abstract

Comparative effectiveness research suggests that conservative management (CM) strategies are no less effective than active initial treatment for many men with localized prostate cancer. We estimate longer-term costs of initial management strategies and potential US health expenditure savings by increased use of conservative management for men with localized prostate cancer. Five-year total health expenditures attributed to initial management strategies for localized prostate cancer were calculated using commercial claims data from 1998 to 2006, and savings were estimated from a US population health-care expenditure model. Our analysis finds that patients receiving combinations of active treatments have the highest additional costs over conservative management at $63 500, followed by $48 550 for intensity-modulated radiation therapy, $37 500 for primary androgen deprivation therapy, and $28 600 for brachytherapy. Radical prostatectomy ($15 200) and external beam radiation therapy ($18 900) were associated with the lowest costs. The population model estimated that US health expenditures could be lowered by 1) use of initial CM over all active treatment ($2.9-3.25 billion annual savings), 2) shifting patients receiving intensity-modulated radiation therapy to CM ($680-930 million), 3) foregoing primary androgen deprivation therapy($555 million), 4) reducing the use of adjuvant androgen deprivation in addition to local therapies ($630 million), and 5) using single treatments rather than combination local treatment ($620-655 million). In conclusion, we find that all active treatments are associated with higher longer-term costs than CM. Substantial savings, representing up to 30% of total costs, could be realized by adopting CM strategies, including active surveillance, for initial management of men with localized prostate cancer.

Costs of conservative management of early-stage prostate cancer compared to radical prostatectomy–a claims data analysis

“…Only the study by Perlroth et al [11] reports that from year 2 of the study on costs of CM become equal to costs of RP [11]. Perlroth et al do not state unit costs of the surveillance scheme; however, other US-based studies show that the unit costs of prostate biopsy ($605–$1102) alone are considerably higher in the US health-care context than unit costs of the whole surveillance scheme (PSA testing and biopsy) in Germany (€44) [6, 8, 24].…”

A Totally Absorbable Multilayer PLGA Implant Device Containing Doxorubicin Inhibited Tumor Growth and Metastasis without Systemic Toxicity in Murine Breast Cancer and an Ideal Pharmacological Paradigm for Regional Chemotherapy

“…Beside the breast cancer situation discussed before, it can be useful for solid cancer with predictable origin. For some slow growing prostate cancers, if a single deposit of an STID can retard the cancer growth or its metastasis, it will be welcome news for frail patients who are physically not fit for surgery or chemotherapy [37]. Even the most benign radiation therapy can exhaust an advanced-age patient, or one who has much co-morbidity.…”

Radiation Costing Methods: A Systematic Review

“…The disease site most often evaluated in rt costing studies was prostate cancer (39%) 7,9,10,[15][16][17][18]24,27,29,31,32,34 , followed by breast cancer (18%) 8,19,22,25,26,28 , non-smallcell lung cancer (12%) 20,23,37,39 , head-and-neck cancer (9%) 14,33,38 , cervical cancer (6%) 13,21 , and other sites [bone metastases (6%) 12,30 , metastatic epidural spinal cord (3%) 36 , oropharyngeal cancer (3%) 35 , and squamous cell cancer of the anus (3%) 11 ]. Thirteen studies used original costing data to conduct the costing analysis 8,19,20,[24][25][26]28,[29][30][31][32][33]37 ; the remaining twenty studies modelled outcomes using hypothetical patient cohorts 7,…”

“…As shown in Figure 2, twenty-two studies provided costs for imrt 7,[9][10][11]14,[16][17][18][19][20][21][22][23][24]27,28,29,[31][32][33][34][35] ; sixteen, for 3D-c rt 11,14,15,17,19,20,22,23,28,[31][32][33][34][35]37,39 ; six, for bt 9,13,22,24,31,32 ; and six, for sbrt 7,10,20,23,27,37 . A number of studies also costed other modalities of rt (rt in general, whole-breast radiation, external-beam partial-breast irradiation, etc.…”