title: Cost implications of the rapid adoption of newer technologies for treating prostate cancer.
abstract: OBJECTIVE
  Intensity-modulated radiation therapy (IMRT) and laparoscopic or robotic minimally invasive radical prostatectomy (MIRP) are costlier alternatives to three-dimensional conformal radiation therapy (3D-CRT) and open radical prostatectomy for treating prostate cancer. We assessed temporal trends in their utilization and their impact on national health care spending.
  
  
  METHODS
  Using Surveillance, Epidemiology, and End Results-Medicare linked data, we determined treatment patterns for 45,636 men age ≥ 65 years who received definitive surgery or radiation for localized prostate cancer diagnosed from 2002 to 2005. Costs attributable to prostate cancer care were the difference in Medicare payments in the year after versus the year before diagnosis.
  
  
  RESULTS
  Patients received surgery (26%), external RT (38%), or brachytherapy with or without RT (36%). Among surgical patients, MIRP utilization increased substantially (1.5% among 2002 diagnoses v 28.7% among 2005 diagnoses, P < .001). For RT, IMRT utilization increased substantially (28.7% v 81.7%; P < .001) and for men receiving brachytherapy, supplemental IMRT increased significantly (8.5% v 31.1%; P < .001). The mean incremental cost of IMRT versus 3D-CRT was $10,986 (in 2008 dollars); of brachytherapy plus IMRT versus brachytherapy plus 3D-CRT was $10,789; of MIRP versus open RP was $293. Extrapolating these figures to the total US population results in excess spending of $282 million for IMRT, $59 million for brachytherapy plus IMRT, and $4 million for MIRP, compared to less costly alternatives for men diagnosed in 2005.
  
  
  CONCLUSIONS
  Costlier prostate cancer therapies were rapidly and widely adopted, resulting in additional national spending of more than $350 million among men diagnosed in 2005 and suggesting the need for comparative effectiveness research to weigh their costs against their benefits.
authors.affiliation: Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA. pnguyen@LROC.harvard.edu
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.forename: Xiangmei
authors.initials: X
authors.lastname: Gu
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: Toni K
authors.initials: TK
authors.lastname: Choueiri
authors.forename: Wesley W
authors.initials: WW
authors.lastname: Choi
authors.forename: Yin
authors.initials: Y
authors.lastname: Lei
authors.forename: Karen E
authors.initials: KE
authors.lastname: Hoffman
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000191:economics / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D004059:Diffusion of Innovation; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008495:Medical Oncology / Q000191:economics* / Q000379:methods; D006278:Medicare / Q000191:economics; D018803:Models, Economic; D011468:Prostatectomy / Q000191:economics / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D018714:Radiotherapy, Adjuvant / Q000191:economics; D050397:Radiotherapy, Intensity-Modulated / Q000191:economics / Q000706:statistics & numerical data; D012371:Robotics / Q000191:economics / Q000706:statistics & numerical data; D018426:SEER Program; D025321:Surgery, Computer-Assisted / Q000191:economics / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States