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

Abstract

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.

An economic evaluation of conservative management and cryotherapy in patients with localized prostate cancer

“…to compared cryotherapy with brachytherapy and found that the cost of cryotherapy was $12 629 (reported in 2008 dollar value). The literature also suggests that conservative management is the least expensive option when compared to the other active treatments . The lower cost estimates for conservative management may be due to lower rates of side effects or no involvement of surgical techniques as in cryotherapy.…”

“…The costs associated with terminal phases of care were the highest in both cohorts. The costs of treatment in cancer are projected to rise with increasing number of cases among older adults, higher survival rates and increasing costs of therapies . A recent international commission suggested that one of the ways to reduce cancer care costs is to improve end‐of‐life care or terminal care .…”

“…The literature also suggests that conservative management is the least expensive option when compared to the other active treatments. [38][39][40] The lower cost estimates for conservative management may be due to lower rates of side effects or no Cost of conservative management and cryotherapy Surbhi Shah et al…”

“…The costs of treatment in cancer are projected to rise with increasing number of cases among older adults, higher survival rates and increasing costs of therapies. [39] A recent international commission suggested that one of the ways to reduce cancer care costs is to improve end-of-life care or terminal care. [41] Care in the terminal phases of cancer is expensive and sometimes ineffective; therefore, providing palliative care could be particularly beneficial in reducing costs and improving quality of life.…”

“…Summary statistics, including means and standard deviations, were also obtained accordingly. As cost data are highly skewed, differences in the phase‐specific costs between the cohorts were assessed using a gamma distributed generalized linear model with a log link function for each phase . All analyses were performed using SAS statistical software (version 9.4; SAS Institute, Cary, NC, USA).…”