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Report: How Prostate Cancer Therapies Compare by Cost and Effectiveness

Surgery ranks as most cost-effective treatment (Jan. 4)

Researchers at the University of California, San Francisco have conducted a retrospective study to compare how the major types of prostate cancer treatments stack up to each other in terms of survival and cost effectiveness.

The investigators analyzed 232 papers published during the last decade that reported results from clinical studies involving patients with low-, intermediate-, and high-risk prostate cancer who received one or more standard treatments (i.e., radiation therapy, surgery, hormone therapies, and brachytherapy).

The analysis — published in the British Journal of Urology International — showed that, for people with low-risk prostate cancer, the various forms of treatment varied only slightly in terms of survival. Radiation therapy, however, was significantly more expensive than surgery for low-risk prostate cancer, the researchers found.

For intermediate- and high-risk cancers, both survival and cost generally favored surgery over other forms of treatment. Radiation therapy was consistently more expensive than surgical methods, with costs ranging from $19,901 for robot-assisted prostatectomy for low-risk disease, to $50,276 for combined radiation therapy for high-risk disease. “Our findings support a greater role for surgery for high-risk disease than we have generally seen in most practice settings,” said lead author Matthew Cooperberg, MD, MPH.

According to the National Cancer Institute, localized prostate cancer — defined as tumors that have not spread outside the gland — accounts for approximately 81% of the 250,000 cases of prostate cancer that occur in the U.S. each year.

Many forms of treatment are available for localized disease: surgery (open, laparoscopic, or robot-assisted); radiation therapy (dose-escalated three-dimensional conformal radiation therapy, intensity-modulated radiation therapy, and brachytherapy); hormone therapies; and combinations of these treatments.

“There is very little solid evidence that one [approach] is better than another,” said Cooperberg.

The study did not consider two other treatment approaches: active surveillance, where patients with low-risk cancer are followed closely with blood tests and biopsies in lieu of active treatment; and proton therapy, which is much more expensive and is not considered to be cost-effective, Cooperberg said.

Sources: UCSF; January 4, 2013; and BJUI; December 28, 2012.

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