Cost-Effectiveness of Traditional Treatment vs Active Surveillance in Low-Risk Prostate Cancer


Researchers presenting at the 2018 ASCO Genitourinary Cancers Symposium (February 8-10, 2018; San Francisco, CA) compared the costs associated with two different approaches to management of low-risk prostate cancer and gave a recommendation toward a value-based care model.

Health care costs in the United States continue to increase at a high rate, with prostate cancer expected to incur a cost of $18.53 billion in the coming years.

Franklin D Gaylis, MD, FACS, Genesis Healthcare Partners (San Diego, CA), and colleagues conducted a study to examine the costs associated with managing low-risk prostate cancer with traditional treatment options compared with active surveillance. A total of 195 patients were identified with having National Comprehensive Cancer Network (NCCN)-defined low-risk prostate cancer (Gleason score 6 or less, PSA less than 10, clinical stage T1c to T2a) between January 2012 and June 2013 at Genesis Healthcare Partners. Among these patients, 48.7% (n = 93) had at least 3 years of follow-up care and formed the cohort for analysis.

Treatment paths analyzed included active surveillance, radical prostatectomy, stereotactic body radiation therapy (SBRT), and intensity-modulated radiation therapy/image guided radiation therapy (IMRT/IGRT).

Patient charts were assessed for all episodes of care during the 3-year period subsequent to their first positive biopsy. Cost attribution to each episode was based on a cost-to-Medicare perspective using the Medicare Physician Fee Schedule for Genesis Healthcare Partners. Total and annual costs of care were compared for patients using a one-way analysis of covariance, factoring patient age and Charlson Comorbidity Index.


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Lowest total 3-year costs were observed for active surveillance ($4072) compared with radical prostatectomy ($9972), SBRT ($26,294), and IMRT/IGRT ($40,438). Additionally, specific characteristics for the active surveillance cohort’s treatment path included an average number of biopsies (2.0) and only 21% of patients had at least one MRI performed during their treatment path.

In their concluding remarks, Dr Gaylis and colleagues wrote that active surveillance may be considered a cost-effective, beneficial management strategy for low-risk prostate cancer. “The cost-effective benefit, as well as the avoidance of treatment (ie, surgery, radiation therapy) related to side effects, support [active surveillance’s] consideration as a value-based care model, the primary goal of MACRA,” they added.—Zachary Bessette