Long-term financial costs associated with prostate cancer treatment

The financial burden related to prostate cancer management over five years is substantial and sustained, according to a new study. Published in the February 1, 2007 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the study reveals that the cumulative cost of prostate cancer is, on average, $42,570 over five years. Watchful waiting was the least expensive treatment while radiation and androgen deprivation therapy were the most expensive. The longitudinal study was the first to look at all related healthcare costs associated with all prostate cancer treatments cumulatively over time and for all ages and disease risks. The cost patterns also indicate that these therapies were appropriately utilized according to current guidelines for disease risk and age. Therefore some therapies are actually costly because they are being appropriately used for higher risk or older patients.

More than 200,000 men are diagnosed with prostate cancer every year in the United States, but the treatment options are controversial. For each treatment, questions about efficacy and concerns about life-altering adverse effects raise concerns about cost versus benefit. While studies often report immediate treatment costs, most ignore the impact of side effects and longer term considerations, such as relapse. Although age and individual risk play a role in treatment decisions, these are often not controlled for in cost studies. In addition, no studies compare the costs of all treatments.

Leslie S. Wilson, Ph.D., Department of Clinical Pharmacy, School of Pharmacy and School of Medicine of the University of California, San Francisco and co-investigators examined patterns of healthcare use over time and compared the interval costs of all prostate-related treatments over five and a half years of 4,553 newly diagnosed men stratified by age, risk, and ethnicity. For the first time, a study identified and included prostate cancer treatment failure and adverse effects that incur cost. "This unique demonstration of long-term cumulative costs is a particular strength of this paper," the authors write, "and should assist those making cost comparisons among treatment types."

The team of investigators found that prostate-related expenditures were substantial in the long-term and varied by treatment type, risk and age. In the first six months, the mean cost after treatment was $11,495 and was directly impacted by treatment type. Cost ranged from only $2,568 for watchful waiting to $24,204 for external beam radiation. This initial treatment choice was, not surprisingly, affected by a patient's age and disease risk. Not surprisingly, older, high risk patients often required more expensive therapies, such as external beam radiation and androgen deprivation therapy, while younger, lower risk patients often required the less expensive prostatectomy.

Subsequent annual cost was found to average $7,740 and ranged from $5,843 for watchful waiting to $12,590 for androgen deprivation therapy. Cumulative mean cost over 5.5 years for all risk groups was $42,570, with watchful waiting costing the least at $32,135 and androgen deprivation therapy costing the most at $69,244.

Overall, these results "demonstrate that prostate-related costs per person are substantial and sustained over time, and that the short-term treatment cost comparisons most commonly found in the literature are not truly reflective of the cost of treatment choices over the long-term," conclude Dr. Wilson and co-authors.

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Article: "Cumulative Cost Pattern Comparison of Prostate Cancer Treatments," Leslie S. Wilson, Ross Tesoro, Eric P. Elkin, Natalia Sadetsky, Jeanette M. Broering, David M. Latini, Janeen DuChane, Reema R, Mody, Peter R. Carroll, CANCER; Published Online: December 21, 2006 (DOI: 10.1002/cncr.22433); Print Issue Date: February 1, 2006.


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