Economical data and advanced prostate carcinoma: do we need new guidelines for decision making?
Based on epidemiological data of incidence, estimated prevalence of advanced prostate carcinoma in Germany, and the cost of androgen deprivation of different regimens were determined in a study model. We analyzed data, published by the Tumor Registry of Munich, which indicate that from 3,838 patients with carcinomas of the prostate, 38% has been treated exclusively with hormone suppression therapy, 14% of patients had undergone a combined radiation therapy and hormone suppression therapy and 9% underwent combined surgical therapy and hormone suppression therapy. The mean survival time of patients treated with medical therapy alone, for patients treated with combined radiation therapy and medical therapy were 60, 24, and 120 months, respectively. The cost for orchiectomy was estimated as $1,072, and for LH-RH therapy as $224/month. We estimated an incidence of 17,700 (per year) and a prevalence of 115,000 patients with advanced prostate cancer for Germany. Provided all patients received LH-RH treatment a total cost of $308,000,000/year would arise. Provided, all patients underwent surgery a total cost of $19,000.000/year would arise. If all patients received LH-RH agonists, the treatment would amount to $16,944 per patient, independently of the prognostic group; and for surgery $1,072 per patient would arise. Limited health care budgets mandate critical determination and evaluation of costs to provide a component for the complex decision making process. However, they must be complimented by validated data of quality of life, which can than be a basis for new guidelines of decision making.
Rohde
Volker
V
Clinic of Urology, Justus Liebig University of Giessen, D-35393 Giessen, Germany. vrohde@gmx.de
Wellmann
Axel
A
Fogt
Franz
F
Weidner
Wolfgang
W
Katalinic
Alexander
A
D000230:Adenocarcinoma / Q000191:economics* / Q000401:mortality / Q000628:therapy; D000726:Androgen Antagonists / Q000191:economics / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003365:Costs and Cost Analysis; D003657:Decision Making; D018450:Disease Progression; D007987:Gonadotropin-Releasing Hormone / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D008297:Male; D009919:Orchiectomy / Q000191:economics; D017410:Practice Guidelines as Topic; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000191:economics* / Q000401:mortality / Q000628:therapy; D015996:Survival Rate; D016896:Treatment Outcome
D000726:Androgen Antagonists; D007987:Gonadotropin-Releasing Hormone; D017430:Prostate-Specific Antigen