title: The burden of out-of-pocket and indirect costs of prostate cancer.
abstract: BACKGROUND
  Out-of-pocket and indirect (OPI) costs play an important role in prostate cancer (PCa) outcomes research. We sought to analyze OPI costs of newly diagnosed PCa patients receiving either radical prostatectomy (RP) or external beam radiation therapy (EBRT).
  
  
  METHODS
  Prospective cohort design was used to recruit 512 newly diagnosed PCa patients from urology clinics of an urban academic hospital and a Veterans Administration medical center. Participants provided demographic information and completed self-reported generic and prostate-specific Health Related Quality of Life (HRQoL) and indirect-cost surveys at baseline and at 3, 6, 12, and 24 months follow-up. Linear mixed models were applied to study the association between OPI costs, treatment and HRQoL outcomes. Propensity scores adjusted for potential confounders and Bonferroni correction was used to account for multiple testing.
  
  
  RESULTS
  Total mean OPI costs varied between RP group and EBRT group at 3-month ($5576 vs. $2010), 6-month ($1776 vs. $2133), 12-month ($757 vs. $774), and at 24-month follow-up ($458 vs. $871). Linear mixed models indicated that RP was associated with lower medication costs (OR = 0.61, CI = 0.48-0.89) and total OPI costs (OR = 0.71, CI = 0.64-0.92). Total OPI costs were inversely related to most of the generic HRQoL items. Similarly, prostate-specific HRQoL items of urinary function (OR = 0.72; adjusted-CI = 0.58-0.84), bowel function (OR = 0.96; adjusted-CI = 0.78-0.98), sexual function (OR = 0.85; adjusted-CI = 0.72-0.92), urinary bother (OR = 0.79; adjusted-CI = 0.67-0.83), and sexual bother (OR = 0.88; adjusted-CI = 0.76-0.93) were inversely related to OPI costs.
  
  
  CONCLUSIONS
  OPI costs of PCa care are substantial and vary across time and treatment.
authors.affiliation: Department of Medicine, School of Medicine, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA..
authors.forename: Ravishankar
authors.initials: R
authors.lastname: Jayadevappa
authors.forename: J Sanford
authors.initials: JS
authors.lastname: Schwartz
authors.forename: Sumedha
authors.initials: S
authors.lastname: Chhatre
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Gallo
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Wein
authors.forename: S Bruce
authors.initials: SB
authors.lastname: Malkowicz
mesh_terms: D000368:Aged; D017281:Cost of Illness; D017048:Health Care Costs; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006304:Health Status; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy / Q000191:economics; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D011788:Quality of Life; D011878:Radiotherapy / Q000191:economics; D014481:United States