Comparison of urologist reimbursement for managing patients with low-risk prostate cancer by active surveillance versus total prostatectomy

Manoharan, M.; Eldefrawy, Ahmed; Katkoori, Devendar; Antebi, E; Soloway, Mark S.

doi:10.1038/pcan.2010.34

Cited by 11 publications

(4 citation statements)

References 19 publications

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“…Although this analysis calculated costs over a relatively long period of time, the study did not include costs of other common treatment modalities for prostate cancer, such as radiotherapy, that are substantially more expensive. As previously noted, Manoharan and colleagues demonstrated that urologist reimbursement for managing a man with active surveillance equals that of upfront RP after 3 to 4 years of surveillance 10. These data demonstrate that adoption of an active surveillance strategy can be financially rewarding, yet still result in net health care savings.…”

Section: Discussionmentioning

confidence: 66%

“…This may effectively tailor treatment to the biologic behavior of an individual's specific prostate cancer 9. Furthermore, Manoharan and colleagues10 noted in an interesting analysis that the reimbursement for urologists using active surveillance may exceed the remuneration for other forms of initial prostate cancer treatment after 3 to 4 years of follow‐up. In addition, Hayes et al11 recently evaluated the quality‐adjusted life expectancy of prostate cancer treatments via an important theoretical decision analysis.…”

Section: Introductionmentioning

confidence: 99%

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Active surveillance for prostate cancer compared with immediate treatment

Keegan

Dall′Era

Durbin‐Johnson³

et al. 2011

Cancer

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BACKGROUND The costs associated with a contemporary active surveillance strategy compared with immediate treatment for prostate cancer are not well characterized. The purpose of this study is to elucidate the health care costs of an active surveillance paradigm for prostate cancer. METHODS A theoretical cohort of 120,000 men selecting active surveillance for prostate cancer was created. The number of men remaining on active surveillance and those exiting to each of 5 treatments over 5 years were simulated in a Markov model. Estimated total costs after 5 years of active surveillance with subsequent delayed treatment were compared with immediate treatment. Sensitivity analyses were performed to test the effect of various surveillance strategies and attrition rates. Additional analyses to include 10 years of follow-up were performed. RESULTS The average simulated cost of treatment for 120,000 men initiating active surveillance with 5 years of follow-up and subsequent delayed treatment resulted in per patient cost savings of $16,042 (95% confidence interval [CI], $16,039-$16,046) relative to initial curative treatment. This represents a $1.9 billion dollar savings to the cohort. The strict costs of active surveillance exceeded those of brachytherapy in the ninth year of follow-up. A yearly biopsy within the active surveillance cohort increased costs by 22%, compared with every other year biopsy. At 10 years of follow-up, active surveillance still resulted in a cost benefit; however, the savings were reduced by 38% to $9944 (95% CI, $9941-$9948) per patient relative to initial treatment. CONCLUSIONS These data demonstrate that active surveillance represents a considerable cost savings over immediate treatment for prostate cancer in a theoretical cohort after 5 and 10 years of follow-up.

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Section: Discussionmentioning

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Active surveillance for prostate cancer compared with immediate treatment

Keegan

Dall′Era

Durbin‐Johnson³

et al. 2011

Cancer

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“…Perlroth et al do not state unit costs of the surveillance scheme; however, other US-based studies show that the unit costs of prostate biopsy ($605–$1102) alone are considerably higher in the US health-care context than unit costs of the whole surveillance scheme (PSA testing and biopsy) in Germany (€44) [6, 8, 24]. Because of the limited study duration only short-term costs can be assessed in this study; as published studies do, however, suggest that cost differences between CM and curative treatment, especially RP, arise in the first years after treatment, the results of this study may support the conclusion that costs of CM do not arise to costs of RP in a lifetime perspective [25]. …”

Section: Discussionmentioning

confidence: 69%

Costs of conservative management of early-stage prostate cancer compared to radical prostatectomy–a claims data analysis

Brandes

Koerber

Schwarzkopf

et al. 2016

BMC Health Serv Res

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BackgroundDue to widespread PSA testing incidence rates of localized prostate cancer increase but curative treatment is often not required. Overtreatment imposes a substantial economic burden on health care systems. We compared the direct medical costs of conservative management and radical therapy for the management of early-stage prostate cancer in routine care.MethodsAn observational study design is chosen based on claims data of a German statutory health insurance fund for the years 2008–2011. Three hundred fifty-three age-matched men diagnosed with prostate cancer and treated with conservative management and radical prostatectomy, are included. Individuals with diagnoses of metastases or treatment of advanced prostate cancer are excluded.In an excess cost approach direct medical costs are considered from an insured community perspective for in- and outpatient care, pharmaceuticals, physiotherapy, and assistive technologies. Generalized linear models adjust for comorbidity by Charlson comorbidity score and recycled predictions method calculates per capita costs per treatment strategy.ResultsAfter follow-up of 2.5 years per capita costs of conservative management are €6611 lower than costs of prostatectomy ([−9734;−3547], p < 0.0001). Complications increase costs of assistive technologies by 30% (p = 0.0182), but do not influence any other costs. Results are robust to cost outliers and incidence of prostate cancer diagnosis. The short time horizon does not allow assessing long-term consequences of conservative management.ConclusionsAt a time horizon of 2.5 years, conservative management is preferable to radical prostatectomy in terms of costs. Claims data analysis is limited in the selection of comparable treatment groups, as clinical information is scarce and bias due to non-randomization can only be partly mitigated by matching and confounder adjustment.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1886-4) contains supplementary material, which is available to authorized users.

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“…The fee-for-service structure of US health care incentivizes providers to treat men with newly diagnosed prostate cancer, although models have estimated that-long term-AS is associated with greater total clinician reimbursement than radical prostatectomy. 50 For many clinicians, the uncertainty around the accuracy of clinical prostate-cancer staging limits their confidence in recommending AS. In the United States, few men who are young and free of comorbid disease at the time of prostate cancer diagnosis undergo AS.…”

Section: Rationale For Asmentioning

confidence: 99%