Despite national guidelines advising against prostate cancer screening in men 70 or older, researchers from the University of North Carolina (UNC) Lineberger Comprehensive Cancer Center found that prostate cancer care for this demographic costs Medicare more than $400 million a year, according to a study published online Sept 13 in JAMA Oncology.
"The tough discussions that happen in health economics are often cases where care is beneficial, but costly. That's a hard trade-off, but this one is actually easier than that," said lead author Justin Trogdon, PhD, associate professor of health policy management in the UNC Gillings School of Global Public Health, in a prepared statement. "This is a scenario where care is probably not beneficial and also costly, and we are putting a dollar figure on just how costly this is."
Trogdon and colleagues analyzed diagnostic and financial data of nearly 50,000 men 70 or older who were diagnosed with prostate cancer between 2004 and 2007. They found that Medicare costs were roughly $1.2 billion for three years following diagnosis, with the average per-patient cost being $14,453. Treatment accounted for 73 percent of the total.
The researchers advised that if patients who have a Gleason score of 6—patients who are at low-risk of developing prostate cancer—choose active surveillance, Medicare could save $320 million a year. Additionally, if patients over the age of 75 chose this approach, it could save Medicare $132 million.
Screening men with at least a 10-year life expectancy and treating those with more aggressive cancer may help eliminate unnecessary spending while ensuring the best patient outcomes, according to the researchers.
“With rising healthcare costs, it is imperative for research to identify areas of lower value health care services,” Trogdon et al. wrote. “Cessation of aggressive treatment of low-risk prostate cancer among elderly patients represents an opportunity to benefit the patient—by preventing harm from treatments that are unlikely to lead to improved survival—while also providing large annual cost savings to Medicare.”