How much does treating low-risk PCa really cost?

Using time-driven activity-based costing, researchers say they’ve uncovered a wide variation in costs to treat low-risk prostate cancer. 

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“This is the first study to truly investigate the costs of various treatments for prostate cancer over the long-term. As we move from traditional fee-for-service reimbursement models to accountable care organizations and bundled payments to curb growing health care expenditures, understanding the true costs of health care is essential,” said first author Aaron Laviana, MD, of UCLA, in a press release from that institution.

The study, which was published online in Cancer (Nov. 2, 2015), was met with praise from one expert, who said the findings will be of interest not only to practicing urologists but also patients and payers.

The authors described cost across the low-risk prostate cancer care process by developing process maps for each phase of care from the first urologic visit through 12 years of follow-up for robot-assisted laparoscopic prostatectomy, cryotherapy, high-dose rate and low-dose rate brachytherapy, intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy, and active surveillance. They factored in costs of materials, equipment, personnel, and space.

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According to the study’s findings, the authors found substantial cost differences at 5 years, with costs ranging from $7,298 for active surveillance to $23,565 for intensity-modulated radiation therapy.

They found low-dose rate brachytherapy, at $8,978, was notably less expensive than high-dose rate brachytherapy, at $11,448.

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Stereotactic body radiation therapy, at $11,665, was less expensive than IMRT-a savings they attributed to shorter procedure times and fewer visits required for stereotactic body radiation, according to the release.

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Equipment costs and the need for an inpatient stay, costing $2,306, contributed to the high price tag associated with robot-assisted laparoscopic prostatectomy, at $16,946.

And cryotherapy, costing $11,215, was more expensive than low-dose rate brachytherapy, driven by increased single-use equipment costs of $6,292 versus $1,869 for brachytherapy.

Active surveillance reached cost equivalence with low-dose rate brachytherapy after 7 years of follow-up. However, even when accounting for the fact that 30% to 50% of patients eventually opt out of active surveillance due to tumor upstaging or anxiety, active surveillance still remained slightly less than robotic prostatectomy.

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This study will be of great interest to practicing urologists, patients, and payers according to David F. Penson, MD, MPH, of Vanderbilt University Medical Center, Nashville, TN, who commented on the study for Urology Times.

“This study confirms what I think many of us suspect-that active surveillance may be a very cost-effective therapeutic strategy to manage low-risk localized prostate cancer,” said Dr. Penson, who directs Vanderbilt’s Center for Surgical Quality and Outcomes Research. “Using a different costing strategy than previous studies, this report shows that it takes 7 to 10 years for other strategies, such as brachytherapy or prostatectomy, to reach cost equivalence.”

Next: What surprised Dr. Penson

Dr. Penson said he was surprised that low-dose brachytherapy was relatively less expensive when compared to the other treatments.

“On the surface, this is encouraging. However, given the number of patients who elect [low-dose brachytherapy] and are then given an external beam boost as well, we have to take these findings with a grain of salt. The other point that bears mentioning is the fact that the authors didn’t look at proton beam therapy, which likely is exponentially more expensive than the other treatments,” said Dr. Penson, who was not involved with the study.

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The study highlights the potential value of time-driven activity-based costing in an era focused on value, according to the authors.

“Traditional costing methods often lack transparency and can be arbitrary, preventing the true costs of a disease or treatment from being understood,” Dr. Laviana said. “This costing methodology creates an algorithm that allows organizations to assess their costs and see where they may be able to improve. Altogether, by maintaining similar quality, this will improve the overall value of care delivered.”

It is critically important that urologists consider the cost of care they deliver in the current health care environment, according to Dr. Penson.

“This is not to say that we should consider only costs when making treatment decisions, but we can’t ignore them, either,” Dr. Penson said. “This type of research is critical if we are to understand the cost-effectiveness of our therapy, which really should drive decision-making in 2015. I think the practicing urologist can use these findings when negotiating with payers regarding bundled payments for urologic services. He or she can also use this information to inform patients about the costs of their care and to help them understand the impact of their treatment choices on their out-of-pocket costs.”

More on Prostate Cancer:

Advanced prostate cancer: Why men aren’t speaking up

Prostate cancer test could reduce overtreatment

Long-term PCa surveillance data point to favorable outcomes

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