title: Cost comparison between watchful waiting with active surveillance and active treatment of clinically localized prostate cancer.
abstract: OBJECTIVE
  In part because of concern regarding overtreatment in men with prostate cancer, watchful waiting with active surveillance (WWAS) has been increasingly used in men diagnosed with low-risk prostate cancer. The present study investigates the difference in costs between men with low-risk prostate cancer treated with up-front radical prostatectomy (RP) versus WWAS.
  
  
  METHODS
  A cost model was constructed using data from centers that have published their results in men who were followed up with WWAS compared with the actual costs of up-front RP calculated from a high volume center. Two WWAS arms of 15-year duration were created in which the follow-up protocol and conversion rate to active treatment were varied.
  
  
  RESULTS
  The cost of up-front RP including costs of surgery, complications, and follow up for 15 years was $15 235 per person. Costs of WWAS were estimated using annual conversion rates from WWAS to RP of both 5% and 7%. Costs per person in the WWAS arms ranged from $6558 to $11 992 in the scenarios created which represent a 43%-78.7% reduction in costs when compared with men undergoing up-front RP.
  
  
  CONCLUSIONS
  Watchful waiting with active surveillance is being increasingly used in hopes of decreasing the potential overtreatment of prostate cancer in men with low-risk disease. The present study suggests that WWAS is likely to markedly decrease costs when compared with active treatment with RP.
authors.affiliation: Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. corcoranat@upmc.edu
authors.forename: Anthony T
authors.initials: AT
authors.lastname: Corcoran
authors.forename: Pamela B
authors.initials: PB
authors.lastname: Peele
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Benoit
mesh_terms: D003365:Costs and Cost Analysis; D006801:Humans; D008297:Male; D011159:Population Surveillance; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000191:economics* / Q000628:therapy*; D012307:Risk Factors