Surgery delivers lower costs, better outcomes than RT for low-risk prostate cancer

A comprehensive cost-effectiveness analysis for localized prostate cancer revealed small differences in patient outcomes and large differences in payer and patient costs across various prostate cancer treatment options, according to a study published online Dec. 28, 2012, in British Journal of Urology International.

Although providers and patients can select from multiple treatment options for localized prostate cancer, few studies have compared the effectiveness and costs of alternative treatments. Thus, Matthew R. Cooperberg, MD, MPH, of the University of California San Francisco Helen Diller Family Comprehensive Cancer Center, and colleagues sought to characterize the costs and outcomes of open, laparoscopic and robot-assisted prostatectomy and 3D conformal radiation therapy (RT), intensity-modulated RT (IMRT), brachytherapy (BT) or combination.

The researchers constructed a Markov model that followed hypothetical men with low-, intermediate- and high-risk prostate cancer over their lifetimes after treatment. They based the model on 232 studies published since 2002.

The model factored in remission, recurrence, salvage treatment, death from prostate cancer and death from other causes and applied costs from a U.S. payer perspective.

“The differences across methods were modest but statistically significant,” wrote Cooperberg and colleagues. 3D conformal RT was the least effective RT method for low-risk men, while external beam RT (EBRT) paired with BT was the most effective RT method for intermediate- and high-risk patients. However, surgical treatments were significantly more effective than RT options in terms of quality-adjusted life years, with the exception of EBRT and BT vs. open radical prostatectomy for high-risk patients.

RT methods imposed higher costs than surgical methods in each risk category. For example, EBRT and BT cost $40,588 for a low-risk patient, approximately double the $19,901 cost of robot-assisted radical prostatectomy for a low-risk patient.

“In general, surgery was preferred over RT for lower-risk men, whereas combined EBRT+BT compared favorably for high-risk men,” wrote Cooperberg et al. Nevertheless, the findings support a greater role for surgical treatment for high-risk disease than generally seen in practice, Cooperberg said in a release.

The current model did not address active surveillance or proton beam therapy. “We agree entirely that for low-risk disease active surveillance may well be preferred to any of the methods included in the present analysis,” wrote the researchers. Active surveillance will be included in future models. In contrast, proton therapy is much more expensive and has already been shown in multiple studies not to be cost-effective, Cooperberg said in a press release.

The researchers concluded, “[The] findings may inform future policy discussions about strategies to improve efficiency and reduce variation in localized prostate cancer care.”

For more about prostate cancer, please read “Prostate Cancer: In the Eye of the Storm,” in Health Imaging magazine.