Tracking the costs of prostate cancer diagnosis and management
Posted Feb 15 2010 12:00am
Two recent studies have examined the increasing economic burden of prostate cancer — in the USA and in selected European nations. The picture is not a pretty one.
In the first of these two studies, Crawford et al. report on an attempt to determine the treatment patterns and resource utilization of various prostate cancer treatments in the USA, and to quantify the economic and clinical impact of each form of treatment. To do this, they conducted a retrospective analysis of medical and pharmacy claims between 2000 and 2005 by identifying 9,035 male patients aged ≥ 40 years of age with a diagnosis of prostate cancer. They then determined the medical and prostate cancer-related expenditures for the various treatment options for three periods: from diagnosis to first treatment, during initial treatment, and after initial treatment.
The results of this study can be summarized as follows:
The average (mean) age of the patients was 61.4 years, and patients aged 50-59 years represented 51 percent of the total.
The majority of patients received some form of active treatment.
Watchful waiting (WW) was the primary means of management for 30 percent of patients.
The average cost for WW over a 2-year period was $24,809.
The average cost for active treatment (presumed to be over a 2-year period) was $59,286.
Surgery was the most common treatment among younger men.
Non-cancer-related costs were similar among those receiving active treatment or WW, but prostate cancer-specific costs were over five times higher in the treated patients.
The second study, by Fourcade et al., addresses the costs of initial treatment of prostate cancer in five European countries. The authors used a variety of sources to calculate costs per patient by disease stage for each country (from the perspective of the payer) during the first year of therapy, including diagnostic costs, and all surgery, radiotherapy, chemotherapy, and hormonal therapy costs as appropriate.
They showed that the average (mean) direct costs per patient for initial treatment were as follows:
€3,698 in Germany
€3,256 in Spain
€3,682 in the UK
€5,226 in Italy
€5,851 in France
They further estimate that the total costs for all diagnosed patients in the first year from diagnosis were €116.7 million in the UK; €244 million in Germany; €385 million in France; €202 in Italy; and €114.6 in Spain. [Editor's note: As of today's date, €1 or 1 euro is equivalent to about $1.36.]
Both papers, independently, reach the same conclusion, which is that the high and increasing prevalence of prostate cancer is placing a significant economic burden on society. While it would be dangerous to conclude — based on these two papers — that the cost of initial treatment over the first year after diagnosis was higher in the USA than in Europe by some specific multiple, it is also clear that the cost of care in the USA is (at best) “significantly” higher than it is in Europe — and it could well be several times higher.
The truth is that such continued costs are not sustainable — in Europe or in America — and we need to implement better management strategies and more cost-efficient processes to lower the international burden of prostate cancer management. If we don’t find ways to do this, it will just become one more of the many straws that finally break the back of the growing global health care budget.