Comparison of the medical costs between active surveillance and other treatment for early prostate cancer in Japan: From the data of PRIAS JAPAN study.

Abstract

280 Background: As the number of prostate cancer patients increases, the cost of treatment is becoming an urgent issue. To compare the costs between active surveillance, robot-assisted laparoscopic prostatectomy (RALP), Brachytherapy (BT), Intensity Modulated Radiation Therapy (IMRT), and Androgen deprivation therapy(ADT). Methods: The costs of protocol biopsies in the first year of AS performed between January 2010 and June 2020, and the treatment costs of RALP, BT, and IMRT performed between May 2019 and June 2020 at Kagawa university hospital were analyzed. The cost of ADT was assumed to be the cost of the LH-RH analog over 5 years. The inpatient treatment cost for each treatment was calculated from our DPC data, and for IMRT, the treatment cost was calculated by the outpatient cost at the time of irradiation. AS-eligible patients were defined as less than 74 years old, less than T2, less than GS6, and less than two positive cores. We estimated the total number of AS-eligible patients in Japan based on the data of the J-CAP study and the data of cancer statistics in 2017 and estimated the total treatment cost of AS-eligible patients based on the data of treatment breakdown of T1/T2 patients in the J-CAP study. In addition, we used the data from PRIAS-JAPAN to calculate the AS continuation rate, protocol biopsy acceptance rate, and the breakdown of secondary treatments. We simulated the 5-year treatment cost for AS patients using the system. Results: The median treatment costs for AS (n = 45), RALP (n = 68), BT (n = 27), and IMRT (n = 44), and ADT were US$1.24 thousand, US$ 14.6 thousand, US$14.8 thousand, US$ 12.9 thousand, and US$8.16, respectively. The number of AS-eligible patients in Japan was estimated to be 5414, and the total cost of AS, RALP, BT, IMRT, HT, and ADT over 5 years was estimated to be US$3.07 million, US$34.8 million, US$8.46 million, US$11.09 million, and US$14.05 million, respectively. If 50% and 100% of the patients in each treatment group chose AS as their first treatment, the total cost of treatment would be reduced by US$18.6 million and US$38.5 million, respectively. Conclusions: The prevalence of AS will contribute to reducing the cost of prostate cancer treatment.