title: Cost implications and complications of overtreatment of low-risk prostate cancer in the United States.
abstract: BACKGROUND
  Evidence-based consensus guidelines recommend only observation for men with low-risk prostate cancer and life expectancy less than 10 years. This report describes the incidence, drivers, cost, and morbidity of overtreatment of low-risk prostate cancer within the United States.
  
  
  METHODS
  The SEER-Medicare Program was used to identify 11,744 men aged 66 years or older diagnosed with low-risk prostate cancer in 2004 through 2007. Overtreatment of prostate cancer was defined as definitive treatment of a patient with a life expectancy of less than 10 years. Expected survival was estimated using NCCN methodology. Costs were the amount paid by Medicare in years after minus year before diagnosis. Toxicities were relevant Medicare diagnoses/interventions. P values are 2-sided.
  
  
  RESULTS
  Of 3001 men with low-risk prostate cancer and a life expectancy of less than 10 years, 2011 men (67%) were overtreated. On multivariable logistic regression, overtreated men were more likely to be married (odds ratio [OR], 1.29; 95% CI, 1.05-1.59; P=.02), reside in affluent regions (P<.001), and harbor more advanced disease at diagnosis (P<.001). Two-year toxicity was greater in overtreated patients (P<.001). Relative to active surveillance/watchful waiting/observation, the median additional cost per definitive treatment was $18,827 over 5 years; the cumulative annual cost attributable to overtreatment in the United States was $58.7 million. The ability to avoid treating the 80% of men with low-grade disease who will never die of prostate cancer would save $1.32 billion per year nationally.
  
  
  CONCLUSIONS
  Overtreatment of low-risk prostate cancer is partially driven by sociodemographic factors and occurs frequently, with marked impact on patient quality of life and health-related costs.
authors.affiliation: From Harvard Radiation Oncology Program, Boston, Massachusetts; Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Statistics, University of Connecticut, Storrs, Connecticut; Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Department of Urology, Brigham and Women's Hospital, Boston, Massachusetts; and Department of Urology, University of California, Los Angeles, Los Angeles, California.
authors.forename: Ayal A
authors.initials: AA
authors.lastname: Aizer
authors.affiliation: From Harvard Radiation Oncology Program, Boston, Massachusetts; Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Statistics, University of Connecticut, Storrs, Connecticut; Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Department of Urology, Brigham and Women's Hospital, Boston, Massachusetts; and Department of Urology, University of California, Los Angeles, Los Angeles, California.
authors.forename: Xiangmei
authors.initials: X
authors.lastname: Gu
authors.affiliation: From Harvard Radiation Oncology Program, Boston, Massachusetts; Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Statistics, University of Connecticut, Storrs, Connecticut; Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Department of Urology, Brigham and Women's Hospital, Boston, Massachusetts; and Department of Urology, University of California, Los Angeles, Los Angeles, California.
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Chen
authors.affiliation: From Harvard Radiation Oncology Program, Boston, Massachusetts; Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Statistics, University of Connecticut, Storrs, Connecticut; Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Department of Urology, Brigham and Women's Hospital, Boston, Massachusetts; and Department of Urology, University of California, Los Angeles, Los Angeles, California.
authors.forename: Toni K
authors.initials: TK
authors.lastname: Choueiri
authors.affiliation: From Harvard Radiation Oncology Program, Boston, Massachusetts; Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Statistics, University of Connecticut, Storrs, Connecticut; Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Department of Urology, Brigham and Women's Hospital, Boston, Massachusetts; and Department of Urology, University of California, Los Angeles, Los Angeles, California.
authors.forename: Neil E
authors.initials: NE
authors.lastname: Martin
authors.affiliation: From Harvard Radiation Oncology Program, Boston, Massachusetts; Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Statistics, University of Connecticut, Storrs, Connecticut; Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Department of Urology, Brigham and Women's Hospital, Boston, Massachusetts; and Department of Urology, University of California, Los Angeles, Los Angeles, California.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Efstathiou
authors.affiliation: From Harvard Radiation Oncology Program, Boston, Massachusetts; Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Statistics, University of Connecticut, Storrs, Connecticut; Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Department of Urology, Brigham and Women's Hospital, Boston, Massachusetts; and Department of Urology, University of California, Los Angeles, Los Angeles, California.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Hyatt
authors.affiliation: From Harvard Radiation Oncology Program, Boston, Massachusetts; Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Statistics, University of Connecticut, Storrs, Connecticut; Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Department of Urology, Brigham and Women's Hospital, Boston, Massachusetts; and Department of Urology, University of California, Los Angeles, Los Angeles, California.
authors.forename: Powell L
authors.initials: PL
authors.lastname: Graham
authors.affiliation: From Harvard Radiation Oncology Program, Boston, Massachusetts; Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Statistics, University of Connecticut, Storrs, Connecticut; Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Department of Urology, Brigham and Women's Hospital, Boston, Massachusetts; and Department of Urology, University of California, Los Angeles, Los Angeles, California.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.affiliation: From Harvard Radiation Oncology Program, Boston, Massachusetts; Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Statistics, University of Connecticut, Storrs, Connecticut; Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Department of Urology, Brigham and Women's Hospital, Boston, Massachusetts; and Department of Urology, University of California, Los Angeles, Los Angeles, California.
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
authors.affiliation: From Harvard Radiation Oncology Program, Boston, Massachusetts; Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Statistics, University of Connecticut, Storrs, Connecticut; Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Department of Urology, Brigham and Women's Hospital, Boston, Massachusetts; and Department of Urology, University of California, Los Angeles, Los Angeles, California.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000191:economics / Q000379:methods; D017281:Cost of Illness; D006801:Humans; D015994:Incidence; D008297:Male; D009017:Morbidity; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D012307:Risk Factors; D018426:SEER Program; D014481:United States / Q000453:epidemiology