Cumulative cost pattern comparison of prostate cancer treatments

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Abstract
BACKGROUND. Studies that compare prostate cancer treatment costs show wide variation. None compare all contemporary treatment costs, and most focus on initial treatment costs. The authors compared healthcare utilization and cost patterns of prostate cancer treatments over a span of 5.5 years in 4553 newly diagnosed patients stratified by age and risk group. METHODS. Contemporary treatment and evaluation patterns for prostate cancer were identified by using CaPSURE, a national disease registry of men with prostate cancer that included ongoing clinical data collection from 31 academic and community urology practices and biennial patient‐reported outcome questionnaires that included demography, medical condition, comorbidity, risk measures, and healthcare utilization. Costs of outpatient visits, medications, and hospitalizations were applied from various national sources. Recurrent events analysis (MCF) accounted for left and right censorship. A mixed effects regression model with bootstrapping for skewed cost data quantified the relation between MCF cost, age, and risk. RESULTS. Prostate‐related costs in the first 6 months after treatment were $11,495, (from $2586 for watchful waiting (WW) to $24,204 for external beam radiation. After 6 months, average cost was only $3044. Annual cost is $7740, highest for androgen deprivation therapy ($12,590) and lowest for watch waiting ($5843). Risk and age were significantly related to initial treatment choice. Cumulative cost ($42,570) allowed a better estimate of treatment pattern costs. CONCLUSIONS. The cost burden of prostate cancer is high, but it varies by treatment type even when controlling for disease, age, and stage. Cumulative cost analysis allowed inclusion of adverse events and disease recurrence costs, making new cost comparisons evident among treatments. Cancer 2007;109:518–527. © 2006 American Cancer Society.