According to a media release from the American Cancer Society, a paper newly published online in Cancer suggests that some treatments for prostate cancer that are relatively low cost in the short term (i.e., in the first 12 months after treatment) may have higher costs over 5 years.
The abstract of the new paper by Snyder et al. is not yet available on line on either the PubMed web site or on the Cancer journal web site, so at present we are entirely dependent on the data in the American Cancer Society’s media release.
Snyder et al. are said to have used data from the Surveillance, Epidemiology and End Results (SEER)-Medicare database to assess costs associated with treatment of 13,769 men aged 66 or older who received treatment for early stage prostate cancer in 2000 and who were then followed for up to 5 years. The patients were classified based on the treatment they received during the initial 9 months after diagnosis (watchful waiting, radiation, hormonal therapy, hormonal therapy + radiation, and surgery). Patients receiving surgical treatment as their primary therapy may also have received radiation and/or hormone therapy in that 9-month period, depending on the initial outcome after surgery.
Treatment costs were assessed according to time periods: the initial costs (months -1 to 12), the long-term costs (each 12 months thereafter), and the total costs (months -1 to 60). The incremental costs of care were calculated as the difference in medical costs for these prostate cancer patients versus a group of similar men without cancer.
The investigators found the following results:
- For most prostate cancer cases, costs were highest in the initial year; they then dropped sharply and remained steady over the next several years.
- Cost patterns varied widely in the short-term and long-term based on initial treatment received.
- Watchful waiting was associated with the lowest initial costs ($4,270) and total costs ($9,130).
- Initial treatment costs were highest for patients who received hormonal therapy + radiation ($17,474), followed by those undergoing surgery ($15,197).
- Hormonal therapy had the second lowest initial costs but the highest total costs ($26,896).
- Hormonal therapy + radiation ($25,097) and surgery ($19,214) had the second and third highest total costs.
- After excluding the last 12 months of life (because patterns of costs are quite different in the period prior to death), total costs were highest for hormonal therapy + radiation ($23,488) and hormonal therapy only ($23,199).
While these data do indeed “provide new information for patients, providers, and payers involved in prostate cancer care” (as stated ion the media release), it is hard to know just how meaningful or helpful they really are. There are good reasons why carefully selected patients should and do have hormone therapy or radiation + hormone therapy as opposed to expectant management or surgery. And if these patients are the ones being diagnosed with more advanced forms of disease, it is hardly surprising that it would prove more costly to treat them over a 5-year time frame. There are also many patients who are probably over-treated or treated unnecessarily when they could simply have been monitored.
And then one has to consider (a) whether these data, based on patients diagnosed in 2000, are entirely relevant for patients being diagnosed today — a decade later; (b) whether a 5-year follow-up is appropriate for a disease that is commonly associated with 15 or more years of survival post-diagnosis; and (c) whether a lower age limit of 66 is sufficiently inclusive of the costs of treatment for the many men now being diagnosed in their 50s and early 60s as opposed to their mid-60s and older.
We suggest you make of this what you will. We have doubts about drawing any significant conclusions from this paper.
Filed under: Living with Prostate Cancer, Management, Treatment | Tagged: 1 year, 5 years, cost, Treatment |
THE "NEW" PROSTATE CANCER INFOLINK 
The goal of the ACS and the purpose of this research are not clear. It would be useful if the ACS explained what conclusions have they reached based on this analysis.
I fully agree with Sitemaster that this is an unclear study and many underlying assumptions should be explained for it to be useful.
One obvious result is that PSA screening at an early age (40 or 45) will lead to detection of prostate cancer at an earlier stage and successful treatment using the most cost-efficient treatment: surgery. Detection and subsequent treatment while the cancer is localized and at an early stage will reduce the need for adjuvant and salvage radiation (with or without hormone therapy) and, in consequence, a lower total treatment cost for surgery.
Contrary to the first paragraph (“According to a media release from the American Cancer Society, a paper newly published online in Cancer suggests that some treatments for prostate cancer that are relatively low cost in the short term (i.e., in the first 12 months after treatment) may have higher costs over 5 years.”) the data quoted shows that surgery results in the lowest treatment cost: initial and total.
Initial treatment cost:
— Hormone therapy+ radiation: $17,474
— surgery: $15,197
Total treatment cost:
— Hormone therapy: $26,896
— Radiation + hormone therapy: $25,097
— Surgery: $19,214
Watchful waiting should not be included, since it’s not treatment, but continuous monitoring.
From the above, it is clear that surgery incurs the lowest cost.
The abstract of the article by Snyder et al. is now available on line.
The objective of the American Cancer Society in publicizing this article is simple: increase readership of the journal Cancer, which they own. There is no prostate cancer-specific objective.
Expectant management (e.g., watchful waiting) is an appropriate means by which to manage carefully selected patients with prostate cancer, as are hormone therapy and surgery and radiation therapy.
Since the full text of the article is still not available, I do not believe one can draw the conclusions suggested by Reuven in his comment above (from either the media release or the abstract).
One has to wonder if the cost of medical care has gone up tremendously since then or if the people they tracked just happened to find very inexpensive places to get treated? Getting a rogue tumor in my back radiated was $22,000 by itself. The price of Casodex is through the roof. Zometa and quarterly hormone treatments cost thousands of dollars each. Toss in a few CT scans, bone scans, x-rays, and don’t even get me started on the cost of various chemotherapy drugs and your costs can quickly, easily total six figures even before that final period which can dwarf all else with its costs. It would appear that this study is just about as useful as comparing the costs of various car brands 10, 15, or 20 years ago. Interesting, but of very, very limited relevance in the current era.
John,
I wonder if you have in your possession the cost of surgery. A friend in my support group told me he had RALP a couple of years ago and the cost was $33,000.
It would be interesting to check the numbers. It seems to me that, compared to radiation and/or hormone therapy, surgery may be the most cost-effective treatment.
Current costs for a radical prostatectomy appear to be as low as $14,000 up to numbers of the order of $75,000 (inclusive of all associated costs). Dr Krongrad and I know this because we spent some time looking into it.
There are many factors involved (not least, who is doing the operation and at what institution). Of course the large insurance providers can negotiate “bulk” rates which are rarely available to the uninsured patient who has to pay the entire cost personally, but the single most critical question is whether you are comparing apples to apples. In other words, is the cost you are quoted inclusive of all surgical costs, all operating room costs, all anesthesiology costs, all other hospital costs, all pathology costs, etc., etc.
The only place I know where you can get an actual price quotation for a radical prostatectomy on the Web if you are an uninsured patient in the USA is through the web site of The Fridays Initiative (a service of Mobile Surgery International).
Sitemaster,
Thanks for the clarification. To the best of my knowledge the $33,000 was the total price, but since the spread is so big — $14,000 to $75,000 — almost any figure is meaningless.