title: Prostatectomy at high-volume centers improves outcomes and lowers the costs of care for prostate cancer.
abstract: BACKGROUND
  High-volume surgeons with ⩾250 radical prostatectomies provide superior oncological outcomes as evidenced by a lower rate of PSA recurrence (PSAR). The financial benefits of performing prostatectomies at high-volume centers (HVC) are unexplored.
  
  
  METHODS
  A base case--referent scenario--where the share of prostatectomies at high- and low-volume centers were evenly divided at 50% was defined. Additional scenarios with increasing shares of prostatectomies at HVC with 10% increments were also modeled. Using a lower probability of PSAR as the only advantage of more experienced surgeons, the savings that would result from fewer recurrences, avoidance of salvage radiation therapy (SRT) and management of fewer men with metastatic cancer were calculated.
  
  
  RESULTS
  The savings associated with performing 80% of radical prostatectomy at HVC were $177, $357 and $559 per prostatectomy at 5, 10 and 20 years, respectively. These savings would offset referral costs of up to $1833 per prostatectomy referral at no additional total societal costs. Given the longer average biochemical failure-free survival with prostatectomies at HVC, referral costs of more than $1833 may be cost effective.
  
  
  CONCLUSIONS
  Under the conservative assumption of accounting for lower rates of PSAR as the only benefit of surgery in an HVC, performing prostatectomies at an HVC was associated with savings that may offset part of the initial referral costs.
authors.affiliation: Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Barzi
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Klein
authors.affiliation: Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
authors.forename: T B
authors.initials: TB
authors.lastname: Dorff
authors.affiliation: Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
authors.forename: D I
authors.initials: DI
authors.lastname: Quinn
authors.affiliation: Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Sadeghi
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011468:Prostatectomy / Q000191:economics / Q000379:methods*; D011471:Prostatic Neoplasms / Q000191:economics / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D016879:Salvage Therapy / Q000191:economics* / Q000379:methods; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen