[Managing patients with prostate cancer in Italy during the first year after diagnosis. A cost description based on a sample of 8 urological wards].
OBJECTIVE
The aim of the paper is to report of an empirical retrospective study (1994-1999) on the cost of managing patient with prostate cancer (PC) during the first year after diagnosis in Italy.


METHODS
In January 2000, a questionnaire on qualitative, quantitative and economic data concerning the clinical path expected for patients with PC (diagnosis; staging; follow-up; drug; surgery; chemotherapy and radiotherapy) was sent to 14 Italian urological wards (UWs), 5 school of medicine-based (Northern Italy: 2; Central Italy: 1; Southern Italy: 2), 4 self-governing hospital-based (Northern Italy: 1; Southern Italy: 3), 5 Health Authorities hospital-based (Northern Italy: 2; Central Italy: 2; Southern Italy: 1). UWs were expected to contribute to analysis with 15 patients' records per year each, for a total amount of 1.260 filled questionnaires. Only medical costs related to patient management have been considered; hospitals and Health Authorities overheads were not taken into account. A cost description was performed considering the hospital viewpoint.


RESULTS
We received 416 out of 1.260 expected questionnaires (redemption rate: 33%) from 8 out of 14 UWs: 2 school of medicine-based (Central Italy: 1; Southern Italy: 1); 2 self-governing hospital-based (Southern Italy: 2); 4 Health Authorities hospital-based (Northern Italy: 1; Central Italy: 3). Only 411 out of 416 questionnaires were included in data analysis. Patients' average age at the time of diagnosis was 74.1 years (range: 68.6-76.7). A moderate percentage of neoplasms in patients' relatives was reported (17.8%; 5.6% for PC). The average cost per patient with CP during the first year after diagnosis was Euro 6,575.31 (range: Euro 5,035.65-Euro 12,367.69). The cost-driver was drug therapy (43.07%), followed by surgery (26.41%), diagnosis (12.39%), staging (8.58%); follow-up (8.25%) and radiotherapy (1.30%); no data on chemotherapy was reported. Diagnosis, staging and follow-up tests and procedures were performed mainly in outpatient setting (81.84% 53.30% and 94.72%, respectively) and requested by hospital urologists (70.26%; 52.88% and 67.95%, respectively). Total PSA was the most frequent test for diagnosis (503 out of 2,047 procedures) and follow-up (782 out of 3,351 procedures), as well as bone scan was for staging (337 out of 1,023 procedures). As far as drug therapy is concerned, LHRH-analogue was the most prescribed drug (227 patients). Surgery (lymphoadenectomy: 9; orchidectomy: 20; urinary outlet dysobstruction: 51; prostatectomy: 104) was performed in 179 patients; 5 out of 179 patients underwent more than one surgical intervention. Radiotherapy (338 sessions) was undertaken in 15 out of 411 patients.


CONCLUSIONS
Cost of managing patient with PC during the first year after diagnosis in Italy could be reduced by increasing outpatient procedures and decreasing post-surgery hospital stay. Our research may hopefully foster further empirical studies on the health economics of PC in our country.
Lazzaro
Carlo
C
Economista Sanitario, Milano, Italy. carlo.lazzaro@tin.it
D000368:Aged; D003365:Costs and Cost Analysis; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008297:Male; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires