Another comparison of treatments costs

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Another study comparing average (not patient specific) costs of various prostate cancer treatments

The estimates of EBRT costs did not specify type of radiation delivery.

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Active surveillance vs. treatment for low-risk prostate cancer: A cost comparisonUrologic Oncology: Seminars and Original Investigations j.urolonc.2011.04.005Received 1 February 2011; revised 13 April 2011; accepted 17 April 2011. Available online 25 May 2011. http://www.sciencedirect.com/science/article/pii/S1078143911001347

Ahmed Eldefrawy M.D./a, Devendar Katkoori M.D./a, Abramowitz M.D./b, Mark S. Soloway M.D./a and Murugesan Manoharan M.D., FRCS, FRACS/a, , a Department of Urology, School of Medicine, University of Miami, Miami, FL 33101, USAb Department of Radiation Oncology, School of Medicine, University of Miami, Miami, FL 33101, USA

AbstractObjective Radical prostatectomy (RP) and radiation therapy are standard curative approaches for low-risk prostate cancer (PC). Active surveillance (AS) is becoming an increasingly accepted management alternative for low-risk PC. Our aim is to compare the cumulative medical costs of treatment vs. AS.

Methods and materials

We collected data on the cumulative medical costs of open radical retropubic prostatectomy (RRP), robotic-assisted radical prostatectomy (RARP), external beam radiotherapy (EBRT), brachytherapy (BT), and AS at our institution. For physicians' reimbursements, Medicare values of our region were used to maintain uniformity. For inpatient costs other than reimbursements, we used the mean cost at our institution.

The costs of RRP and RARP involve preoperative investigations, medical clearance, physicians' fees, inpatient costs, and pathologic examination of prostatectomy specimen and follow-up. The inpatient costs include the operating room, disposable equipment, anesthesia, post-anesthesia care, transfusion, and hospital stay.

The cost of EBRT involves the cost of consultation, planning, simulation and treatment sessions, and follow-up.

BT costs involved radiotherapy planning as well as inpatients costs. AS protocol involves regular visits, transrectal ultrasound guided biopsies, prostate specific antigen (PSA) testing.

To evaluate the cost of treating complications, treatment after AS, and treatment for recurrence, we created a Markov model based on recent studies and our experience.

Results

The cumulative costs of RRP are $9,732 (1 year), $10,360 (2 years), $12,209 (5 years), and $15,084 (10 years). While for RARP, the costs are $17,824 (1 year), $18,308 (2 years), $20,117 (5 years), and $22,762 (10 years). The costs of EBRT are $20,730 (1 year), $20,969 (2 years), $22,043 (5 years), and $23,953 (10 years). BT costs are $14,061 (1 year), $14,300 (2 years), $15,374 (5 years), and $17,284 (10 years). The costs of AS are $1,154 (1 year), $2,308 (2 years), $8,761 (5 years), and $13,116 (10 years)