Active surveillance is a viable management strategy for patients with favorable-risk prostate cancer and is associated with 2-year cost-savings over surgery and radiation, according to a study (Eur Urol Open Sci. 2021;23:20-29. doi:10.1016/j.euros.2020.11.004).
“Prostate cancer is the most common cancer in men and second leading cause of cancer-related deaths. Changes in screening guidelines, adoption of active surveillance, and implementation of high-cost technologies have changed treatment costs,” wrote Christopher J. Magnani, MD, MS, School of Medicine, Stanford University, California, and colleagues.
“Traditional cost-effectiveness studies rely on clinical trial protocols unlikely to capture actual practice behavior, and existing studies use data predating new technologies,” they continued, adding that real-world evidence reflecting these changes is lacking.
The aim of this study was to assess real-world costs of first-line prostate cancer management.
Electronic health records associated with the California Cancer Registry and Medicare Fee Schedule from 2008 to 2018 were used for the study. Costs were assessed over a 24-month period or 60-month period following prostate cancer diagnosis.
Surgery or radiation treatments were identified with structured methods. Active surveillance was identified with structured data and natural language processing.
The main outcome measure was risk-stratified calculated cost per day for first-line management, independent of treatment duration.
A total of 3433 patients with prostate cancer who received surgery (54.6%), radiation (22.3%), or active surveillance (23%) were included in the study.
At 2 years after diagnosis, active surveillance ($2.97 per day) was found to be less costly than surgery ($5.67 per day) or radiation ($9.34 per day) among patients with favorable disease. Surgery ($7.17 per day) was less costly than radiation ($16.34 per day) for patients with unfavorable disease.
At 5 years after diagnosis, active surveillance ($2.71 per day) remained slightly less costly than surgery ($2.87 per day) and radiation ($4.36 per day) in patients with favorable disease. Surgery ($4.15 per day) remained cheaper than radiation ($10.32 per day) for those with unfavorable disease.
“[Active surveillance] is a viable management strategy that can be encouraged to optimize the quality of life in select patients with favorable-risk disease; using real-world data, we found that initial costs may be reduced with [active surveillance], although these savings may not hold for patients followed over extended periods,” Dr Magnani and colleagues concluded.
“Generally, definitive treatment with surgery appears less costly than radiation in both favorable and unfavorable disease,” they added.—Janelle Bradley
