title: Health care costs for state transition models in prostate cancer.
abstract: To obtain estimates of direct health care costs for prostate cancer (PC) from diagnosis to death to inform state transition models.
  
  
  
  A stratified random sample of PC patients residing in 3 geographically diverse regions of Ontario, Canada, and diagnosed in 1993-1994, 1997-1998, and 2001-2002, was selected from the Ontario Cancer Registry. We retrieved patients' pathology reports to identify referring physicians and contacted surviving patients and next of kin of deceased patients for informed consent. We reviewed clinic charts to obtain data required to allocate each patient's observation time to 11 PC-specific health states. We linked these data to health care administrative databases to calculate resource use and costs (Canadian dollars, 2008) per health state. A multivariable mixed-effects model determined predictors of costs.
  
  
  
  The final sample numbered 829 patients. In the regression model, total direct costs increased with age, comorbidity, and Gleason score (all P < 0.0001). Radical prostatectomy was the most costly primary treatment health state ($4676 per 100 days). Radical prostatectomy, hormone-refractory metastatic disease ($6398 per 100 days), and final (predeath) ($13,739 per 100 days) health states were significantly more costly (P < 0.05) than nontreated nonmetastatic PC ($3440 per 100 days), whereas the postprostatectomy ($732 per 100 days) and postradiation ($1556 per 100 days) states cost significantly less (P < 0.0001).
  
  
  
  This study used an innovative but labor-intensive approach linking chart and administrative data to estimate health care costs. Researchers should weigh the potential benefits of this method against what is involved in implementation. Modifications in methodology may achieve similar gains with less outlay in individual studies. However, we believe that this is a promising approach for researchers wishing to advance the quality of costing in state transition modeling.
authors.affiliation: Department of Medicine, Toronto, ON, Canada (MDK, SMHA, GT, GN).|Faculty of Pharmacy, Toronto, ON, Canada (MDK)|Institute of Health Policy, Management, and Evaluation, Toronto, ON, Canada (MDK, SMHA, GT, GN, BZ)|Toronto Health Economics and Technology Assessment Collaborative (THETA), Toronto, ON, Canada (MDK, SMHA, WC, GT, NM, GN, KEB)|Toronto General Hospital, University Health Network, Toronto, ON, Canada (MDK, SMHA, GT, KEB)|Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (MDK, BZ)
authors.forename: Murray D
authors.initials: MD
authors.lastname: Krahn
authors.affiliation: Toronto Health Economics and Technology Assessment Collaborative (THETA), Toronto, ON, Canada (MDK, SMHA, WC, GT, NM, GN, KEB)|Toronto General Hospital, University Health Network, Toronto, ON, Canada (MDK, SMHA, GT, KEB)
authors.forename: Karen E
authors.initials: KE
authors.lastname: Bremner
authors.affiliation: Institute of Health Policy, Management, and Evaluation, Toronto, ON, Canada (MDK, SMHA, GT, GN, BZ)|Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (MDK, BZ)
authors.forename: Brandon
authors.initials: B
authors.lastname: Zagorski
authors.affiliation: Department of Medicine, Toronto, ON, Canada (MDK, SMHA, GT, GN).|Institute of Health Policy, Management, and Evaluation, Toronto, ON, Canada (MDK, SMHA, GT, GN, BZ)|Toronto Health Economics and Technology Assessment Collaborative (THETA), Toronto, ON, Canada (MDK, SMHA, WC, GT, NM, GN, KEB)|Toronto General Hospital, University Health Network, Toronto, ON, Canada (MDK, SMHA, GT, KEB)|Baycrest Geriatric Health Care System and Toronto Rehabilitation Institute, Toronto, ON,Canada (SMHA, GN)
authors.forename: Shabbir M H
authors.initials: SM
authors.lastname: Alibhai
authors.affiliation: Toronto Health Economics and Technology Assessment Collaborative (THETA), Toronto, ON, Canada (MDK, SMHA, WC, GT, NM, GN, KEB)
authors.forename: Wendong
authors.initials: W
authors.lastname: Chen
authors.affiliation: Department of Medicine, Toronto, ON, Canada (MDK, SMHA, GT, GN).|Institute of Health Policy, Management, and Evaluation, Toronto, ON, Canada (MDK, SMHA, GT, GN, BZ)|Toronto Health Economics and Technology Assessment Collaborative (THETA), Toronto, ON, Canada (MDK, SMHA, WC, GT, NM, GN, KEB)|Toronto General Hospital, University Health Network, Toronto, ON, Canada (MDK, SMHA, GT, KEB)
authors.forename: George
authors.initials: G
authors.lastname: Tomlinson
authors.affiliation: Toronto Health Economics and Technology Assessment Collaborative (THETA), Toronto, ON, Canada (MDK, SMHA, WC, GT, NM, GN, KEB)
authors.forename: Nicholas
authors.initials: N
authors.lastname: Mitsakakis
authors.affiliation: Department of Medicine, Toronto, ON, Canada (MDK, SMHA, GT, GN).|Institute of Health Policy, Management, and Evaluation, Toronto, ON, Canada (MDK, SMHA, GT, GN, BZ)|Toronto Health Economics and Technology Assessment Collaborative (THETA), Toronto, ON, Canada (MDK, SMHA, WC, GT, NM, GN, KEB)|Baycrest Geriatric Health Care System and Toronto Rehabilitation Institute, Toronto, ON,Canada (SMHA, GN)
authors.forename: Gary
authors.initials: G
authors.lastname: Naglie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D011471:Prostatic Neoplasms / Q000191:economics* / Q000473:pathology*; D012923:Social Class
keywords: costs; economic evaluation; prostate cancer