Cumulative cost pattern comparison of prostate cancer treatments.
BACKGROUND
Studies that compare prostate cancer treatment costs show wide variation. None compare all contemporary treatment costs, and most focus on initial treatment costs. The authors compared healthcare utilization and cost patterns of prostate cancer treatments over a span of 5.5 years in 4553 newly diagnosed patients stratified by age and risk group.


METHODS
Contemporary treatment and evaluation patterns for prostate cancer were identified by using CaPSURE, a national disease registry of men with prostate cancer that included ongoing clinical data collection from 31 academic and community urology practices and biennial patient-reported outcome questionnaires that included demography, medical condition, comorbidity, risk measures, and healthcare utilization. Costs of outpatient visits, medications, and hospitalizations were applied from various national sources. Recurrent events analysis (MCF) accounted for left and right censorship. A mixed effects regression model with bootstrapping for skewed cost data quantified the relation between MCF cost, age, and risk.


RESULTS
Prostate-related costs in the first 6 months after treatment were 11,495 dollars, (from 2586 dollars for watchful waiting (WW) to 24,204 dollars for external beam radiation. After 6 months, average cost was only 3044 dollars. Annual cost is 7740 dollars, highest for androgen deprivation therapy (12,590 dollars) and lowest for watch waiting (5843 dollars). Risk and age were significantly related to initial treatment choice. Cumulative cost (42,570 dollars) allowed a better estimate of treatment pattern costs.


CONCLUSIONS
The cost burden of prostate cancer is high, but it varies by treatment type even when controlling for disease, age, and stage. Cumulative cost analysis allowed inclusion of adverse events and disease recurrence costs, making new cost comparisons evident among treatments.
Wilson
Leslie S
LS
Department of Medicine, University of California, San Francisco, California 94143, USA. wilsonL@pharmacy.ucsf.edu
Tesoro
Ross
R
Elkin
Eric P
EP
Sadetsky
Natalia
N
Broering
Jeanette M
JM
Latini
David M
DM
DuChane
Janeen
J
Mody
Reema R
RR
Carroll
Peter R
PR
D000368:Aged; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000191:economics* / Q000628:therapy; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000191:economics* / Q000473:pathology / Q000628:therapy; D013997:Time Factors