title: Comparative effectiveness, cost, and utilization of radical prostatectomy among young men within managed care insurance plans.
abstract: BACKGROUND
  Costs and benefits of emerging prostate cancer treatments for young men (age < 65 years) in the United States are not well understood. We compared utilization, clinical outcomes, and costs between two types of radical prostatectomy (RP)--minimally invasive prostatectomy (MIRP) and retropubic prostatectomy (RRP)--among young patients.
  
  
  METHODS
  We extracted from LifeLink Health Plan Claims Database, a commercial claims database, information on 10,669 patients receiving either MIRP or RRP between 2003 and 2007. In unadjusted analyses, we used chi-square tests to compare clinical outcomes and nonparametric bootstrapping method to compare costs between the MIRP and RRP groups. We applied logistic, Cox proportional hazard, and extended estimation equation methods to examine the association between surgical modality and perioperative complications, anastomotic stricture, and costs while controlling for age, comorbidity, and health plan characteristics.
  
  
  RESULTS
  The percentage of prostatectomies performed as MIRP increased from 5.7% in 2003 to 50.3% in 2007. Patients with more comorbidity were more likely to undergo RRP than MIRP. Compared with the RRP group, the MIRP group had a significantly lower rate of perioperative complications (23.0% vs. 30.4%; P < 0.001) and a lesser tendency for anastomotic strictures (hazard ratio 0.42; 95% CI 0.35-0.50) within the first postoperative year but had higher hospitalization costs ($19,998 vs. $18,424; P < 0.001) despite shorter hospitalizations (1.7 days vs. 3.1 days; P < 0.001). Similar findings were reported in the subgroup analysis of patients with comorbidity score 0.
  
  
  CONCLUSIONS
  MIRP among nonelderly patients increased substantially over time. MIRP was found to have fewer complications. Lower costs of complications appeared to have offset higher hospitalization costs of MIRP.
authors.affiliation: Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL 60637, USA. tshih@medicine.bsd.uchicago.edu
authors.forename: Ya-Chen Tina
authors.initials: YC
authors.lastname: Shih
authors.forename: John F
authors.initials: JF
authors.lastname: Ward
authors.forename: Curtis A
authors.initials: CA
authors.lastname: Pettaway
authors.forename: Ying
authors.initials: Y
authors.lastname: Xu
authors.forename: Surena F
authors.initials: SF
authors.lastname: Matin
authors.forename: John W
authors.initials: JW
authors.lastname: Davis
authors.forename: Benjamin P
authors.initials: BP
authors.lastname: Thompson
authors.forename: Linda S
authors.initials: LS
authors.lastname: Elting
mesh_terms: D000293:Adolescent; D000328:Adult; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008329:Managed Care Programs / Q000191:economics*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D016016:Proportional Hazards Models; D011468:Prostatectomy / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000601:surgery*; D014481:United States; D055815:Young Adult