Cost of continuing prostate cancer care highlights potentially unnecessary excess
MedWire News: Although the initial phase of treatment for prostate cancer represents the greatest financial cost in overall prostate cancer care, the continuing care phase has the most variation in expenditure, report US researchers.
The magnitude of variation in expenditure among low-risk patients is substantially greater than that between low- and high-risk patient groups for androgen deprivation therapy (ADT), say the researchers in Journal of Urology.
“Variation was evident across the spectrum of disease severity and implies the need for better evidence to inform clinical practice,” write Brent Hollenbeck and colleagues from the University of Michigan in Ann Arbor.
The team investigated continuing care and its relative contribution to the near US$7 billion (€ 5.7 billion) prostate cancer costs in the USA.
They identified 10,961 Medicare-receiving prostate cancer patients aged 66 to 99 years old, and assigned their treatment payments to the initial phase of care (the 12 months after diagnosis), continuing care (all care after 12 months until the end of life), and end of life care (the last 12 months of life).
Patients were also ranked by average continuing care costs and sorted into five equal expenditure groups.
Overall, the men consumed more than US$ 530 million (€ 431 million) in Medicare payments from 1992–2005, with the initial treatment phase costing the most (58%) followed by continuing care (32%), and end of life care (10%).
At 7 years into continuing care, expenditures exceeded those of the initial phase in the average cancer survivor, at US$ 10,248 (€ 8,338) versus US $8,799 (€ 7,159).
Continuing care expenditures were relatively independent of prostate cancer risk, note Hollenbeck and team, with more significant variation in cost apparent between quintiles, and little spending difference among risk strata.
Specifically, among ADT-treated low-risk patients, the lowest versus highest spending quintiles were 0.003 versus 2.6 annual per capita use, while low-risk versus high-risk highest spending quartiles were 2.6 versus 3.8 annual per capita use.
Office visits and ADT accounted for the overall majority of physician-related payments at 27.3% and 62.7%. Furthermore, for men in the highest quintiles of expenditure for continuing care, ADT accounted for the majority of physician payments, at approximately US$ 50 million (€ 41 million).
“Decreasing unnecessary ADT provides the greatest opportunity to decrease cost and improve quality of care for prostate cancer survivors,” say Hollenbeck et al.
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By Sarah Guy