The cost value of medical versus surgical hormonal therapy for metastatic prostate cancer.
OBJECTIVE
The cost of luteinizing hormone releasing hormone analogue and antiandrogen for prostate cancer is being scrutinized by the Health Care Finance Administration and other insurers. We compared the discounted present value cost of medical hormonal therapy to that of orchiectomy as well as the value created by these treatments from the insurer and patient perspectives.


METHODS
We performed a telephone survey of 42 patients receiving hormonal therapy to estimate the value created by medical versus surgical castration from the patient perspective. The cost of medical hormonal therapy was discounted back to the present value and compared with the cost of bilateral orchiectomy.


RESULTS
The total cost of bilateral orchiectomy was $2,022, while the discounted present value cost using the average wholesale price for 30 months of medical hormonal therapy was $13,620. Therefore, medical hormonal therapy costs $11,598 more than orchiectomy ($13,620 - $2,022). A discounted payment of $386 per month for 30 months is necessary to recoup the $11,598 difference. All surveyed patients on medical hormonal therapy stated that avoiding orchiectomy was worth $386 per month and it was an appropriate insurer expense. If patients paid $386 per month out-of-pocket, 22 of the 42 (52%) would pay the additional monthly expense, while 20 (48%) indicated that they could not afford the additional expense.


CONCLUSIONS
These results indicate that medical hormonal therapy costs significantly more than bilateral orchiectomy but creates positive value for men with prostate cancer by enabling them to avoid orchiectomy.
Chon
J K
JK
Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, USA.
Jacobs
S C
SC
Naslund
M J
MJ
D000465:Algorithms; D000726:Androgen Antagonists / Q000191:economics; D018931:Antineoplastic Agents, Hormonal / Q000191:economics*; D001294:Attitude to Health; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000191:economics; D017281:Cost of Illness; D005382:Financing, Personal; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives / Q000191:economics; D017048:Health Care Costs; D017722:Hospital Charges; D006801:Humans; D007343:Insurance Carriers / Q000191:economics; D016729:Leuprolide / Q000191:economics; D008297:Male; D008396:Maryland; D009362:Neoplasm Metastasis; D009919:Orchiectomy / Q000191:economics* / Q000523:psychology; D017060:Patient Satisfaction; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000601:surgery; D015895:Relative Value Scales; D014481:United States
D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D007987:Gonadotropin-Releasing Hormone; D016729:Leuprolide