Watchful waiting markedly less expensive than radical prostatectomy
MedWire News: Watchful waiting (WW) with active surveillance dramatically reduces prostate cancer costs compared with active surgical treatment, say US researchers.
Even if men treated with a WW protocol subsequently convert to active treatment with surgery, overall costs are still lower as the costs of up-front prostate surgery are far higher than the equivalent in WW, the team reports in the journal Urology.
"In addition to the concern for the potential for unnecessary morbidity resulting from overtreatment of prostate cancer," write Anthony Corcoran (University of Pittsburgh, Pennsylvania) and colleagues, "overtreatment will also increase health care costs without a corresponding benefit in terms of years of life saved."
The team constructed a costs model, using data based on Medicare records for 2008, for men treated with WW versus up-front open radical prostatectomy. Surgery is less costly than radiotherapy (the other alternative initial treatment option), and thus bias against active treatment was minimized.
The model accounted for 15 years of follow-up, including a series of office visits for blood and urine analysis for the surgery patients, and a series of prostate biopsies for the WW patients. The model also allowed for a 5-7% chance per year of men converting from WW to radical prostatectomy, prompted by indications that their cancer had become likely to affect their survival.
Overall costs per patient for WW-treated patients ranged between US $6558 (€5166) for a more liberal protocol with biopsies at 18-month intervals, and US $11,992 (€9447) for more conservative protocols involving annual biopsies.
In contrast, the estimated overall cost per radical prostatectomy patient was US $15,235, illustrating that costs per person for WW - including patients who converted to active treatment - were only 43.0-78.7% of the costs of receiving up-front surgery at cancer diagnosis over the whole 15 years.
Changing the cost of radical prostatectomy was the only variable that had a dramatic effect on costs in the model, note Corcoran et al.
"A significant reason for the lower costs associated with WW even when a large proportion of men convert to active treatment is that most of the costs occur in the future whereas more than 90% of costs in the up-front radical prostatectomy arm occur in the first year," the team concludes.
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By Sarah Guy