The cost to treat low-risk prostate cancer has wide variation, according to a new study published in Cancer (2015; doi:10.1002/cncr.29743). The study examined the cost of care from when a patient checks in for his first appointment through his posttreatment follow-up testing via the use of time-driven activity-based costing.
The variation in costs remained consistent over a 12-year period, indicating a better method to monitor costs could save valuable health care dollars, stated first author Aaron Laviana, MD, a fifth-year urology resident at the University of California Los Angeles (UCLA).
“This is the first study to truly investigate the costs of various treatments for prostate cancer over the long-term. As we move from traditional fee-for-service reimbursement models to accountable care organizations and bundled payments to curb growing health care expenditures, understanding the true costs of health care is essential,” Laviana said.
“Traditional costing methods often lack transparency and can be arbitrary, preventing the true costs of a disease or treatment from being understood. This is important, as patients often receive a hospital bill with arbitrary charges that may or may not reflect their true treatment costs. This costing methodology creates an algorithm that allows organizations to assess their costs and see where they may be able to improve. Altogether, by maintaining similar quality, this will improve the overall value of care delivered.”
Laviana said the biggest surprise uncovered by the analysis was the relatively low cost of active surveillance, which uses repeated PSA testing and prostate biopsies to monitor for development of more aggressive disease in younger, healthier patients who might benefit from delaying treatment. Active surveillance costs remained low, even when they factored in the fact that 30% to 50% of patients eventually opt out and choose a definitive treatment.
At 5 years out from diagnosis, active surveillance still remained slightly less expensive than the price of robotic prostatectomy. Active surveillance is an important option to consider for low-risk prostate cancer, Laviana said, given many men who have it are more likely to die from other causes. It also avoids the complications from the traditional treatments of radiation and surgery, including difficulty urinating and problems with erectile dysfunction.
Specifically, Laviana found costs ranging from $7298 for active surveillance to $23 565 for intensity-modulated radiation therapy (IMRT), or conventional radiation therapy delivered in relatively small doses over 8 weeks with patients receiving daily treatments during the process.
The study also found that low-dose rate brachytherapy—inserting small, permanent radioactive seeds into the prostate—was notably less expensive than high-dose rate brachytherapy—inserting higher-dose temporary seeds into the prostate ($8978 vs. $11 448, respectively). Stereotactic body radiation therapy ($11,665) was notably less expensive than IMRT, with the savings attributed to shorter procedure times and markedly fewer visits required for stereotactic body radiation.
In robotic-assisted laparoscopic prostatectomy, both equipment costs and an inpatient stay ($2306) contributed to its high cost of $16 946. Cryotherapy ($11 215) was more costly than low-dose rate brachytherapy, largely because of increased single-use equipment costs of $6292 vs. $1869 for brachytherapy.
“We were surprised in the profound cost differences in radiation therapy based solely on the number of treatments delivered,” Laviana said. “Future studies are needed to determine whether there are differences in outcomes between these modalities.”
For this study, the team determined space and product costs and calculated personnel capacity cost rates. They calculated personnel costs for the prostate cancer treatment team of doctors, nurses, and patient affairs based on the steps of the process. Space and equipment costs also were defined.