Study Shows Wide Variation in Costs to Treat Low-Risk Prostate Cancer

Key Points

  • Active surveillance costs remained low, even when considering the fact that 30% to 50% of patients eventually opt out and choose a definitive treatment.
  • Costs ranged from $7,298 for active surveillance to $23,565 for intensity-modulated radiation therapy. Low–dose rate brachytherapy, at $8,978, was notably less expensive than high–dose rate brachytherapy, at $11,448. Stereotactic body radiation therapy at $11,665 was notably less expensive than intensity-modulated radiotherapy.
  • In robotic-assisted laparoscopic prostatectomy, both equipment costs and an inpatient stay at $2,306 contributed to its high cost of $16,946. Cryotherapy, at $11,215, was more costly than low–dose rate brachytherapy, largely because of increased single-use equipment costs of $6,292 vs $1,869 for brachytherapy.

University of California, Los Angeles (UCLA) researchers have described costs across the entire care process for low-risk prostate cancer—from the time a patient checks in for his first appointment to his post-treatment follow-up testing—using time-driven activity-based costing. For the various available treatments, they discovered wide variations in costs that remained consistent over a 12-year period, indicating that a better method for monitoring costs could save valuable health-care dollars, said lead author Aaron Laviana, MD. These findings were published by Laviana et al in Cancer.

“This is the first study to truly investigate the costs of various treatments for prostate cancer over the long term. As we move from traditional fee-for-service reimbursement models to accountable care organizations and bundled payments to curb growing health-care expenditures, understanding the true costs of health care is essential,” Dr. Laviana said.

“Traditional costing methods often lack transparency and can be arbitrary, preventing the true costs of a disease or treatment from being understood,” he continued. “This is important, as patients often receive a hospital bill with arbitrary charges that may or may not reflect their true treatment costs. This costing methodology creates an algorithm that allows organizations to assess their costs and see where they may be able to improve. Altogether, by maintaining similar quality, this will improve the overall value of care delivered.”

Study Findings

Dr. Laviana said the biggest surprise uncovered by the analysis was the relatively low cost of active surveillance. Active surveillance costs remained low, even when considering the fact that 30% to 50% of patients eventually opt out and choose a definitive treatment.

At 5 years after diagnosis, active surveillance remained slightly less expensive than the price of robotic prostatectomy. Active surveillance is an important option to consider for low-risk prostate cancer, Dr. Laviana said, given that many men who have the disease are more likely to die from other causes. It also avoids complications from the traditional treatments of radiation and surgery, including difficulty urinating and erectile dysfunction.

Specifically, Dr. Laviana and his colleagues found costs ranging from $7,298 for active surveillance to $23,565 for intensity-modulated radiation therapy. The study also found that low–dose rate brachytherapy, at $8,978, was notably less expensive than high–dose rate brachytherapy, at $11,448. Stereotactic body radiation therapy at $11,665 was notably less expensive than intensity-modulated radiotherapy, with the savings attributable to shorter procedure times and markedly fewer visits required for stereotactic body radiotherapy.

In robotic-assisted laparoscopic prostatectomy, both equipment costs and an inpatient stay at $2,306 contributed to its high cost of $16,946. Cryotherapy, at $11,215, was more costly than low–dose rate brachytherapy, largely because of increased single-use equipment costs of $6,292 vs $1,869 for brachytherapy.

“We were surprised about the profound cost differences in radiation therapy based solely on the number of treatments delivered,” Dr. Laviana said. “Future studies are needed to determine whether there are differences in outcomes between these modalities.”

For this study, the team determined space and product costs and calculated personnel capacity cost rates. They calculated personnel costs for the prostate cancer treatment team of doctors, nurses, and patient affairs based on the steps of the process.

Going forward, the UCLA team plans to link the costing analysis to rigorously assessed quality measurements and outcomes trials to see which treatments provide the greatest value. They also plan to expand this study to assessing all levels of prostate cancer to see how the cost of care varies with localized high-risk prostate cancer as well as metastatic disease to analyze the burden of prostate cancer on end-of-life care.

The study was funded by the H & H Lee Surgical Research Scholar Program.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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