Cost of prostate Ca care varies with initial treatment choice

Short-term and long-term costs of prostate cancer care vary considerably based on which treatment strategy a man initially receives, according to a recent study.

The study, published online in Cancer (Aug. 23, 2010), finds that treatments that may be less expensive in the short term may have higher long-term costs.

First author Claire Snyder, PhD, of the Johns Hopkins Bloomberg School of Public Health, Baltimore, led a team that reviewed early-stage prostate cancer cases from the Surveillance, Epidemiology and End Results (SEER) Medicare database. Patients included 13,769 men aged 66 years or older who were diagnosed in 2000 and were followed for 5 years. They were divided into groups based on the treatment they received during the first 9 months after diagnosis: watchful waiting, radiation, hormonal therapy, hormonal therapy plus radiation, and surgery.

Treatment costs were divided into initial, long-term, and total costs. The incremental costs of care were calculated as the difference in medical costs for patients versus a group of similar men without cancer.

The team found that for most prostate cancer cases, costs were highest in the initial year and then dropped sharply and remained steady over the next several years. However, patterns of costs varied widely in the short term and long term based on initial treatment received.

Watchful waiting had the lowest initial ($4,270) and 5-year total costs ($9,130). Initial treatment costs were highest for patients who received hormonal therapy plus radiation ($17,474), followed by those undergoing surgery ($15,197). Hormonal therapy had the second-lowest initial costs but the highest 5-year total costs ($26,896).

"This demonstrates that treatments that may be less expensive in the short term may have higher long-term costs," Dr. Snyder said.

Hormonal therapy plus radiation ($25,097) and surgery ($19,214) had the second- and third-highest 5-year total costs.