Active Surveillance V Prostatectomy Cost Analysis

July 24, 2012 — The cost of providing active surveillance for 10 years to a man with prostate cancer is about the same as the cost of initially performing surgery, according to an economic analysis published in the July 15 issue of Cancer.

The researchers estimated that 10 years of active surveillance costs $28,784 and that an initial radical prostatectomy — and the related 10 years of office follow-up — costs $31,612.

However, some other treatments for prostate cancer are much more expensive than these 2 options. The most expensive treatments include initial image-guided radiation therapy with short-term androgen-deprivation therapy (ADT), which costs $61,131 at 10 years, and long-term ADT, which costs $84,055 at 10 years.

Active Surveillance entails monitoring the cancer with everything except surgery, chemotherapy, hormone therapy (ADT) or radiation.  Should the condition deteriorate, these options will be assessed and a treatment modality will be chosen.

The costs in this article are what Americans pay.  It should be pretty much the same in Australia.  Fortunately for me, I am a pensioner with a ‘Health Card’ which means it is rare that I have to pay for anything – including medications once I reach the ‘Safety Net’ expenditure limit.  Being on a Health Card, I understand there are various treatments such as brachytherapy that are not covered under the Safety net.

Protocol and Individual Costs for Active Surveillance

Procedure	Cost ($)
Prostate biopsy	1102
Pathology costs	660
Professional/technical fees	635
Office consultation	428
Office visit	118
PSA measurement	52
Urologist reimbursement for biopsy	433

The protocol consists of an initial office consultation, 2 prostate biopsies within the first 3 months (diagnostic and confirmatory), pathology costs, professional & technical fees, prostate-specific antigen (PSA) values, and office visits every 3 months for 2 years and every 6 months thereafter.

As noted above, repeat prostate biopsy was performed after the second year of follow-up and every other year thereafter.

For the economic analysis, the researchers assumed that 7.0% of the 120,000 men on active surveillance will exit observation and receive treatment (in years 1 to 5), and that 4.5% will do so later on (years 6 to 10). In total, 30% and 45% will exit by years 5 and 10, respectively, which is in keeping with clinical studies.

In the analysis, the men exiting active surveillance were distributed between different forms of common treatment for localized prostate cancer, including (listed with associated probability) radical prostatectomy (40%), image-guided radiation therapy with or without ADT (25% and 10%, respectively), prostate brachytherapy (15%), and ADT monotherapy (10%).