title: How does initial treatment choice affect short-term and long-term costs for clinically localized prostate cancer?
abstract: BACKGROUND
  Data regarding costs of prostate cancer treatment are scarce. This study investigates how initial treatment choice affects short-term and long-term costs.
  
  
  METHODS
  This retrospective, longitudinal cohort study followed prostate-cancer cases diagnosed in 2000 for 5 years using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Men age≥66 years, in Medicare fee for service, diagnosed with clinically localized prostate cancer in 2000 while residing in a SEER region, were matched to noncancer controls using age, sex, race, region, comorbidity, and survival. On the basis of treatment received during the first 9 months postdiagnosis, patients were assigned to watchful waiting, radiation, hormonal therapy, hormonal+radiation, and surgery (may have received other treatments). Incremental costs for prostate cancer were the difference in costs for prostate cancer cases versus matched controls. Costs were divided into initial treatment (months -1 to 12), long-term (each 12 months thereafter), and total (months -1 to 60). Sensitivity analyses excluded the last 12 months of life.
  
  
  RESULTS
  A total of 13,769 prostate-cancer cases were matched to 13,769 noncancer controls. Watchful waiting had the lowest initial treatment ($4270) and 5-year total costs ($9130). Initial treatment costs were highest for hormonal+radiation ($17,474) and surgery ($15,197). At $26,896, 5-year total costs were highest for hormonal therapy only followed by hormonal+radiation ($25,097) and surgery ($19,214). After excluding the last 12 months of life, total costs were highest for hormonal+radiation ($23,488) and hormonal therapy ($23,199).
  
  
  CONCLUSIONS
  Patterns of costs vary widely based on initial treatment. These data can inform patients and clinicians considering treatment options and policy makers interested in patterns of costs.
authors: Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA. csnyder@jhsph.edu
authors: Claire F
authors: CF
authors: Snyder
authors: Kevin D
authors: KD
authors: Frick
authors: Amanda L
authors: AL
authors: Blackford
authors: Robert J
authors: RJ
authors: Herbert
authors: Bridget A
authors: BA
authors: Neville
authors: Michael A
authors: MA
authors: Carducci
authors: Craig C
authors: CC
authors: Earle
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D002755:Choice Behavior; D004358:Drug Therapy / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D008297:Male; D005791:Patient Care / Q000191:economics*; D057240:Patient Preference; D011468:Prostatectomy / Q000191:economics; D011471:Prostatic Neoplasms / Q000191:economics* / Q000628:therapy*; D011878:Radiotherapy / Q000191:economics; D012189:Retrospective Studies; D018426:SEER Program; D057832:Watchful Waiting / Q000191:economics