Research shows rapid adoption of newer PCa treatments

Newer, more expensive treatment options for prostate cancer were adopted rapidly and widely during 2002 through 2005 without proof of their cost-effectiveness, according to a recent study.

"In an era of limited resources, it is important for us as a society to take stock of how we’re spending our money," said lead author Paul Nguyen, MD, of the Dana-Farber/Brigham and Women’s Cancer Center, Boston. "We don’t think these patterns are unique to prostate cancer but used it as an example and found that in the United States, newer and more expensive technologies were rapidly adopted before we knew if they were worth the added cost-or, in the case of robotic surgery, whether they provide benefits over standard treatment."

For the study, which was published online in the Journal of Clinical Oncology (March 14, 2011), researchers evaluated the use and cost of surgical and radiation treatments for prostate cancer using Surveillance, Epidemiology, and End Results Medicare-linked data from more than 45,000 men aged 65 years or older between 2002 and 2005. The data accounted for patients who received two types of surgical treatments: open radical prostatectomy and robot-assisted or laparoscopic prostatectomy; and two types of radiation treatments: three-dimensional conformal radiation therapy (3-D CRT), and the newer intensity-modulated radiation therapy (IMRT).

Among surgical patients, the number who received robot-assisted or laparoscopic prostatectomy increased substantially from 1.5% of diagnoses in 2002 to 28.7% of diagnoses in 2005. Among patients who received radiation therapy, the researchers observed the same trend toward rapid adoption of IMRT. In 2002, 28.7% of men diagnosed received IMRT compared with 81.7% in 2005.

The authors also reported that Medicare spending on the newer treatment options was significantly higher than on traditional treatments, with the difference between IMRT and 3-D CRT being nearly $11,000 per patient, and the difference between robot-assisted prostatectomy and open radical prostatectomy being $293.

"Our paper should not be interpreted as being 'anti-technology,' and we do not want to stand in the way of bringing newer and better treatments to market," Dr. Nguyen said. "On the other hand, health care spending is a zero-sum game, and a greater emphasis on comparative effectiveness research is needed so we can better separate the wheat from the chaff.

"While IMRT has proven itself to significantly reduce the rate of serious rectal bleeding after prostate radiation, the study to show it is cost-effective was not published until 2006, when over 80% of the country was already using it. In the case of robotic surgery, there are still uncertainties over what benefits it has over the open procedure."