Cancer: Initial prostate cancer treatment decisions affect long-term costs
The patterns in cost of prostate cancer treatment can vary widely based on initial treatment choice, and treatments that may be less expensive in the short-term may have higher long-term costs, according to a study published online Aug 23 in Cancer. 

“Data regarding costs of prostate cancer treatment are scarce,” noted Claire F. Snyder, PhD, from the department of medicine, oncology and health policy & management at Johns Hopkins School of Medicine in Baltimore, and colleagues. However, the authors explained that initial treatment decisions can impact short-term (the first year following diagnosis) and long-term (across five years of follow-up) costs of medical care.

Initial treatment choices for men with early-stage prostate cancer can include surgery, radiation therapy, hormonal treatment, watchful waiting or a combination of methods. Cost can be a factor in determining which treatment will be administered to the patient and in some cases, the choice will be left to the patient, offered the authors.

The researchers retrospectively reviewed prostate cancer cases diagnosed in 2000 for five years using the Surveillance, Epidemiology and End Results (SEER)-Medicare database. The study population consisted of 13,769 men, age 66 and older in Medicare Fee-For-Service, diagnosed with clinically localized prostate cancer while residing in a SEER region. These patients were matched to healthy controls using age, sex, race, region, comorbidity and survival.

Next, the patients were divided into groups based on the treatment they received during the first nine months following cancer diagnosis. The groups included watchful waiting, radiation therapy, hormonal therapy, hormonal plus radiation and surgery (men in this group may have also received hormones or radiation in addition to surgery).  

The treatment costs were divided into initial (months, one to 12), long-term (each 12 months following the first year) and total (months, one to 60) costs. The incremental costs for prostate cancer care were calculated as the difference in medical costs for patients versus a group of similar men without cancer, the authors stated.

Snyder and colleagues found that watchful waiting had the lowest initial treatment ($4,270) and five-year total costs ($9,130). The hormonal plus radiation therapy was associated with the highest initial treatment costs ($17,474), followed by surgery ($15,197). Five-year total costs were highest for hormonal therapy ($26,896) only followed by hormonal plus radiation ($25,097). Total costs were highest for hormonal plus radiation therapy ($23,488) and hormonal therapy ($23,199), after excluding the last 12 months of life, they wrote.  

While costs were highest during the first year, they were found to drop sharply and remain steady over the following years, the researchers noted. However, patterns of costs varied widely in the short-term and long-term based on initial treatment received.   

The results of the study suggest that treatments that may be less expensive in the short-term may have higher long-term costs, offered Snyder. Specifically, hormonal therapy had the second lowest initial costs but the highest five-year total costs. “These data can inform patients and clinicians considering treatment options and policy makers interested in patterns of costs,” the authors concluded.