[The economics of managing patients with prostate cancer].
OBJECTIVE
The aim of the paper is to report on the economics of managing patients with prostate cancer (PC).


METHODS
After a thorough research on MEDLINE, 15 recent articles (1994-2000) concerning the economics of PC have been selected. Costs taken from articles were supplemented with accounting data provided by Research and Teaching Hospital San Raffaele, Milan. Only medical costs have been considered.


RESULTS
In Western countries, PC is becoming one of the most frequent neoplasms among males, with a 20% life-time probability of occurrence. In the near future, the global burden of illness related to PC is expected to grow consistently with the increasing number of 50-aged men. The average survival of PC patients is generally increased, probably due to the improvement of diagnostic tests, instruments and programmes. When targeted to selected classes of men, screening for early diagnosis of PC seems to be cost-effective when compared to "watchful waiting", since cost per Quality-Adjusted Life Year (QALY) gained ranges between US$ 12,502 and US$ 27,025. Healthcare programmes are deemed cost-effective if cost per life year (or per QALY) gained is lower than US$ 50,000. In USA, the total cost for treating PC patients has reached US$ 1,720 billion per year; cost for radical prostatectomy approaches US$ 19,000. The average Italian cost for prostatectomy (Euro 4,000) is hardly covered by Regional DRG reimbursement (Euro 3,600 in Lombardy). When brachytherapy is considered, the gap between cost (Euro 4,806) and DRG tariff (Euro 3,500 in Lombardy) becomes even wider; this difference is mainly due to the high cost of I-125 needles (Euro 55,77 each). In 1997, USA drug expenditure for PC has approached 761 million US$: LH-RH analogues and antiandrogens account for a relevant share of this amount. However, LH-RH analogues can be the only treatment option for a metastatic PC patient who refuses orchiectomy.


CONCLUSIONS
In managing PC, urologists are increasingly faced with healthcare budget constraints. Cost for surgery may be decreased by reducing either operating time or length of hospital stay. Drug expenditure may be cut by choosing the cheapest of drugs with the same effectiveness.
Scattoni
Vincenzo
V
Divisione di Urologia, Università Vita-Salute IRCCS San Raffaele, Milano, Italy. scattoni.vincenzo@hsr.it
Lazzaro
Carlo
C
Rigatti
Patrizio
P
D001918:Brachytherapy; D003365:Costs and Cost Analysis; D006801:Humans; D008297:Male; D011468:Prostatectomy / Q000191:economics; D011471:Prostatic Neoplasms / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D019057:Quality-Adjusted Life Years