1476 COST EXPENDITURES FOR ACTIVE SURVEILLANCE VERSUS ACTIVE TREATMENTS FOR LOCALIZED PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Localized1 Apr 20111476 COST EXPENDITURES FOR ACTIVE SURVEILLANCE VERSUS ACTIVE TREATMENTS FOR LOCALIZED PROSTATE CANCER Rebecca S. Lavelle, Stephen B. Williams, and Kevin R. Loughlin Rebecca S. LavelleRebecca S. Lavelle Boston, MA More articles by this author , Stephen B. WilliamsStephen B. Williams Boston, MA More articles by this author , and Kevin R. LoughlinKevin R. Loughlin Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1411AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance (AS) versus definitive treatments for localized prostate cancer is underutilized. We sought to estimate Medicare cost expenditures for several published AS protocols versus treatment in order to discern whether there is a cost benefit associated with AS. METHODS We reviewed the Klotz, Patel, and Carter et al AS protocols and the National Comprehensive Cancer Network (NCCN) guidelines. Medicare reimbursement fees were derived from the 2010 Current Procedural Terminology (CPT) codes assigned to each of the follow up criteria defined in the AS protocols and NCCN guidelines. The follow up criteria were outlined for each protocol including the following: PSA, DRE, ultrasound guided prostate needle biopsy. The total cost expenditure was calculated at 1, 5, 10 and 15 years after diagnosis. The cost was calculated for a patient who remains on active surveillance without signs of disease progression. We used previously published literature regarding cost expenditures for radical prostatectomy, external beam radiation and brachytherapy treatments. The published literature included estimated cost expenditures from the CaPSURE database (1995–2004), SEER Medicare database (1991–1999), and Health Care Financial Administration public use files (1993–1996). RESULTS The Medicare cost expenditure for AS protocols were estimated to range from $105 to $1,781 at one year and $3042 to $24,362 at fifteen years after diagnosis. For the 6 month period after diagnosis/treatment, the cost expenditure for radical prostatectomy ranged from $12,184–$19,019. The cost expenditure for external beam radiation ranged from $10,996-$24,204, whereas brachytherapy ranged from $7,588–$15,301. CONCLUSIONS Active surveillance is an underutilized management option for patients with low-risk, localized prostate cancer. The cost expenditure for AS protocols varies drastically based on frequency of screening ultrasound needle guided biopsy. Our estimated cost expenditure of the least costly AS protocol (NCCN guidelines) at 15 years does not exceed the initial 6 month cost of treament. The estimated cost expenditure of the most costly AS protocol (Carter et al) does not exceed the initial 6 month cost of treament until 5 years of AS. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e592 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rebecca S. Lavelle Boston, MA More articles by this author Stephen B. Williams Boston, MA More articles by this author Kevin R. Loughlin Boston, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...