Managing localized prostate cancer by radical prostatectomy or watchful waiting: Cost analysis of a randomized trial (SPCG-4).
OBJECTIVE
The cost of radical prostatectomy (RP) compared to watchful waiting (WW) has never been estimated in a randomized trial. The goal of this study was to estimate long-term total costs per patient associated with RP and WW arising from inpatient and outpatient hospital care.


METHODS
This investigation used the Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) trial, comparing RP to WW, and included data from 212 participants living in two counties in Sweden from 1989 to 1999 (105 randomized to WW and 107 to RP). All costs were included from randomization date until death or end of follow-up in July 2007. Resource use arising from inpatient and outpatient hospital costs was measured in physical units and multiplied by a unit cost to come up with a total cost per patient.


RESULTS
During a median follow-up of 12 years, the overall cost in the RP group was 34% higher (p < 0.01) than in the WW group, corresponding to €6123 in Sweden. The difference was driven almost exclusively by the cost of the surgical procedure. The cost difference between RP and WW was two times higher among men with low (2-6) than among those with high (7-10) Gleason score.


CONCLUSIONS
In this economic evaluation of RP versus WW of localized prostate cancer in a randomized study, RP was associated with 34% higher costs. This difference, attributed exclusively to the cost of the RP procedure, was not overcome during extended follow-up.
Department of Urology, Örebro University Hospital, Örebro, Sweden.
Swen-Olof
SO
Andersson
Ove
O
Andrén
Johan
J
Lyth
Jennifer R
JR
Stark
Martin
M
Henriksson
Hans-Olov
HO
Adami
Per
P
Carlsson
Jan-Erik
JE
Johansson
D000368:Aged; D003365:Costs and Cost Analysis; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000191:economics*; D011471:Prostatic Neoplasms / Q000191:economics* / Q000601:surgery / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D057832:Watchful Waiting / Q000191:economics*