UroToday - In the online edition of Prostate Cancer Prostatic Diseases, a group of investigators including Dr. Peter Albertsen reports on costs associated with care for prostate cancer (CaP). The goal of the study was to use the SEER database to calculate the long-term costs by cancer stage. SEER is a cancer registry linked to Medicare claims and represents 26% of the US population between 1991 and 2004.

The study cohort included men with a primary diagnosis of CaP between 1991 and 2002. To determine background medical costs for men without CaP, a 5% sample from the Medicare database was randomly selected and matched in 5-year age groups to the study population. The investigators used a phase-based model to estimate monthly treatment costs. The time periods from diagnosis to death were divided into 3 phases of care: initial, continuing and terminal care. The total average monthly cost of care was calculated for each patient by adding the payment data on each Medicare claim for each treatment phase and then dividing by the total number of follow-up months patients contributed to each phase. The differences between CaP case costs and non-cancer control costs were determined to be CaP costs. Long-term costs were calculated by combining survival data from SEER with phase-specific monthly cost estimates.

One-third of patients did not receive initial active therapy. Radical prostatectomy was greatest for stage III CaP and lowest for stage I, while radiotherapy and brachytherapy were more common among lower versus higher stage patients. The data indicated that cost outliers were driving up the mean monthly costs for each treatment phase and inflating long-term estimates. When patients in the 95-100th percentile of costs were excluded from the analysis, model-based estimates of long-term costs were more consistent with actual mean Medicare payments. The largest difference in monthly costs between CaP patients and controls was in the initial phase with an incremental difference averaging $1,857. This difference increased with increasing disease stage. Monthly terminal care costs for stages I-III were similar to non-cancer patients, but stage IV CaP patients had terminal costs over $1,000 higher versus stages I-III. Regarding survival, 61%, 56%, 55%, and 18% of stages I, II, III, and IV patients were still alive 120 months after diagnosis. Average long-term costs were $57,691 for stage IV patients and decreased to $40,969 for stage I. CaP costs were a significant part of total costs making up 40.5%, 36.2%, 33%, and 43.3% of total costs for stages I, II, III, and IV, respectively.

Stokes ME, Black L, Benedict A, Roehrborn CG, Albertsen P
Prostate Cancer Prostatic Dis. 2010 Mar 9. Epub ahead of print
doi:10.1038/pcan.2010.5

UroToday Contributing Editor Christopher P. Evans, MD, FACS

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