title: An economic analysis of conservative management versus active treatment for men with localized prostate cancer.
abstract: Comparative effectiveness research suggests that conservative management (CM) strategies are no less effective than active initial treatment for many men with localized prostate cancer. We estimate longer-term costs of initial management strategies and potential US health expenditure savings by increased use of conservative management for men with localized prostate cancer. Five-year total health expenditures attributed to initial management strategies for localized prostate cancer were calculated using commercial claims data from 1998 to 2006, and savings were estimated from a US population health-care expenditure model. Our analysis finds that patients receiving combinations of active treatments have the highest additional costs over conservative management at $63 500, followed by $48 550 for intensity-modulated radiation therapy, $37 500 for primary androgen deprivation therapy, and $28 600 for brachytherapy. Radical prostatectomy ($15 200) and external beam radiation therapy ($18 900) were associated with the lowest costs. The population model estimated that US health expenditures could be lowered by 1) use of initial CM over all active treatment ($2.9-3.25 billion annual savings), 2) shifting patients receiving intensity-modulated radiation therapy to CM ($680-930 million), 3) foregoing primary androgen deprivation therapy($555 million), 4) reducing the use of adjuvant androgen deprivation in addition to local therapies ($630 million), and 5) using single treatments rather than combination local treatment ($620-655 million). In conclusion, we find that all active treatments are associated with higher longer-term costs than CM. Substantial savings, representing up to 30% of total costs, could be realized by adopting CM strategies, including active surveillance, for initial management of men with localized prostate cancer.
authors.affiliation: Center for Health Policy, Stanford University, 117 Encina Commons, Stanford, CA 94305-6019, USA. dperl@stanford.edu
authors.forename: Daniella J
authors.initials: DJ
authors.lastname: Perlroth
authors.forename: Jay
authors.initials: J
authors.lastname: Bhattacharya
authors.forename: Dana P
authors.initials: DP
authors.lastname: Goldman
authors.forename: Alan M
authors.initials: AM
authors.lastname: Garber
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000191:economics*; D001918:Brachytherapy / Q000191:economics; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D005102:Health Expenditures; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000191:economics*; D011471:Prostatic Neoplasms / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy; D050397:Radiotherapy, Intensity-Modulated / Q000191:economics*; D057832:Watchful Waiting / Q000191:economics*
chemical_list: D000726:Androgen Antagonists