AS costs significantly lower
The GHP study’s 3-year total cost of AS was $4,072, which was significantly lower (p<.001) than that for radical prostatectomy ($9,972), stereotactic body radiation therapy ($26,294), and intensity-modulated radiation therapy/image-guided radiation therapy (IMRT/IGRT) ($40,438). More than 40% of the differences in cost could be attributed to treatment selection.
By comparison, Keegan et al, using a theoretical cohort of 120,000 men selecting AS, found a cost saving of $16,042 per patient over 5 years and $9,944 over 10 years for AS compared with immediate treatment. Laviana et al made a process map for each treatment and measured costs to the University of California, Los Angeles to provide the service. They found significant cost variation between competing treatments, with 5-year costs lowest with AS ($7,298) and highest for IMRT ($23,565).
“Ours are primary data that confirm the impressions of these theoretical models,” said Dr. Gaylis. “There’s a paradigm shift toward value-based health care in the United States, the goal of which is to improve quality and reduce cost (ie, improve value). Health care costs in the U.S. continue to rise faster than all other developed countries and are approaching 20% of gross domestic product.
“Physicians will play an important role in controlling costs and ensuring optimal value to the care we provide. This is how we should start engaging the dialogue, from a value-based care point of view, and debate how best to measure cost.”
One criticism of his data is the short follow-up. Dr. Gaylis is expanding the follow-up to 5 years.
“We know that the numbers will change as we go out further, and that’s why we are expanding it to 5 years, but the 3-year data still gives us a sense of the magnitude of the difference in costs between immediate treatment and AS,” he said.
Dr. Gaylis has received honorari from, is a consultant/adviser to, and is on the speakers’ bureau for Janssen; is a consultant/adviser for UROGPO; and has received research funding from Astellas Medivation.
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