The Cost of Prostate Cancer Treatment
The Cost of Prostate Cancer Treatment
The Takeaway First
Prostate cancer treatment is expensive. It accounts for 28 percent of all new cancer diagnoses in men and nearly $12 billion in treatment costs, according to the American Cancer Society. Even if health insurance (in the US) pays for portion of the cost, patients often pay some out-of –pocket expense. Recent research shows that Androgen Deprivation Therapy (ADT) increases the risk of several other conditions that are much more expensive in the long run.
The Details
- Heijnsdijk et al. (2015) studied data from the European Randomized Study of Screening for Prostate Cancer (ERSPC) to figure out just how often you have to get a PSA screening for it to be cost-effective.
- According to their analysis, it was most cost-effective for men aged 55-59 to space their screenings two-years apart and to limit the number of screenings to two or three. They also found that PSA screenings for men over the age of 63 were generally cost-ineffective due to over-diagnosis.
- Krahn et al. (2014) studied the indirect costs of one treatment of prostate cancer, ADT, in 26,809 men.
- They found that more than 50% of the men had at least one adverse “event,” which could have been a heart attack, stroke, congestive heart failure, diabetes, or others connected to ADT treatment.
- Adverse events increased the costs of ADT by up to 265%. (about quadruple)
My Take on Prostate Cancer Cost
In 2010, a study (Snyder at al., 2010) from the American Cancer Society about just how much it costs a person, on average, to get treatment for prostate cancer. This report divided costs into initial cost (the first year) and follow-up cost (the following five years) for several different treatment strategies:
- Watchful waiting cost $4270 for the first year and then $9130 after five years.
- For patients who received hormonal therapy plus radiation, initial costs were $17,474, and five-year costs were $25,097.
- The five-year total cost of hormonal therapy was $26,896.
- Surgery had an initial cost of $15,197, five-year cost of $19,214.
These are some staggering figures, so I always stand up and applaud when I find studies like Heijnsdijk’s (don’t ask me how to pronounce this!). This study answers a question that is on every middle-aged man’s lips: how often should I go screen for prostate cancer? But the underlying question is this: how do I minimize both my initial and long-term costs?
Studies conclusions mean only but a small portion when trying to assess what treatment approach is best for patients since every patient that walks into my office or any other doctor’s office is an individual. While there are problems in over-treating prostate cancer, we must make sure we catch those deadly cancer cells early. Bottom line: If you have a significant family history of prostate cancer, then start screening at 40 years-old. If you don’t then screening at 50 to 60 should be fine. And remember higher PSA does not always equals cancer.
On ADT…
ADT involves orchiectomy, or castration, either by surgery or chemically induced with medical drugs. Not only is it frightening to think about, but the recent study by Krahn makes it look cost-ineffective as well. I wonder, though, what kinds of food the men in this study were eating, and how much exercise they were getting day-to-day. If most of them were eating junk and lounging on their couches all day, then I wouldn’t surprised if they had expensive heart problems down the road.
Other cost related factors in prostate cancer treatment
- For advanced prostate cancer generic docetaxel (10 cycles) plus ancillary costs come to $15,000 and provides an overall survival gain of 72 days over control therapy, giving a cost/survival figure of 206.
- Abiraterone (Zytiga, trade name) plus prednisolone for 6 months used in patients who have progressed on docetaxel cost is about $30,000, and survival gain was 117 days.
- Cabazitaxel (Jevtana, trade name) at 25 mg/kg (every 3 weeks, used as second line) costs about $35,000 and provides a survival gain of 73 days.
- Sipuleucel-T (Provenge) – (3 doses) costs $93,000 and provides a survival gain of 123 days,. http://www.medscape.com/viewarticle/779717
The researchers estimated that over-treatment costs $15,308 more per patient than active surveillance, which involves monitoring of prostate-specific antigen (PSA) levels, biopsies, and definitive treatment if the cancer progresses. Definitive treatment includes the cost of treatment and any complications that arise.
When extrapolated nationally, the cumulative net cost of over-treatment in men aged ≥66 years is $32 million per annum,” the researchers conclude.
(2013 Genitourinary Cancers Symposium (GUCS): Abstract 161. Presented February 14, 2013.)
Research to date has not given us a clear picture of how each prostate cancer therapy affects men over the long run,” study lead author Dr. Jay Ciezki, a staff physician at the Cleveland Clinic, said in an ASCO news release. “Our analysis is one of the first to examine the quality of life and financial costs of these three very common prostate cancer treatment strategies for more than five years after treatment.
Other data looks at 137,000 men who received external beam radiation (EBRT), prostatectomy (surgical removal of the prostate) or brachytherapy (“seeds”). Brachytherapy, the researchers noted, resulted in the fewest number of toxicities involving their genital or urinary organs. Brachytherapy also had the lowest cost per patient per year of about $2,557.
A slightly higher number (6.7 percent) of those treated with prostatectomy experienced problems with their genital or urinary organs. This treatment, the study revealed, had a total cost of about $3,206 per patient-year.
Meanwhile, just over 7 percent of patients who received external beam radiation therapy had these adverse effects. This was also the most expensive therapy, at $6,412 per patient.
How about cost of the most common prostate cancer treatment – Prostatectomy?
About 138,000 prostate cancer surgeries are performed yearly, according to government figures. A study from the University of Iowa compared the cost of prostate cancer surgery at 100 hospitals throughout the United States. The quote for the procedure, the researchers found, varied from $10,100 to $135,000 with an average cost of about $35,000, more than double the Medicare reimbursement.
Academic medical centers charged 52 percent more, on average, than non–academic centers
• Hospitals in the northeast U.S. charged most at $40,000 on average while hospitals in the South charged the least. ($30,000 on average)
• Hospitals in the Midwest were the most likely to provide estimates and to offer discounts
The average cost for a physician or for a surgeon was about $8000. It is interesting to note that Medicare allows under $1700 for the procedure and pays 80% of that The average cost for a physician or for a surgeon was about $8000. It is interesting to note that Medicare pays about $1300 per procedure to the surgeon.
What You Should Do & What Does this all Mean?
Given this wide variation in expense, patients who are self-paying are likely to see a very high charge on their bill. Thus, self-paid patients should negotiate the fee almost as if buying a new car – business is business.
I am providing this information mainly to keep you updated and aware of how much each of the various treatments for prostate cancer can cost. If you’re over the age of 55, get screened every few years if not significant prostate cancer history involved. Keep in mind, however, everyone is different and this rule may not apply to all.
If you have questions about what kind of treatments is best for you , if any, consider these 10 points on making the best prostate cancer decision.
References
Heijnsdijk, E. A., de Carvalho, T. M., Auvinen, A., Zappa, M., Nelen, V., Kwiatkowski, M., . . . de Koning, H. J. (2015). Cost-effectiveness of prostate cancer screening: a simulation study based on ERSPC data. J Natl Cancer Inst, 107(1), 366. doi: 10.1093/jnci/dju366
Krahn, M. D., Bremner, K. E., Luo, J., & Alibhai, S. M. (2014). Health care costs for prostate cancer patients receiving androgen deprivation therapy: treatment and adverse events. Curr Oncol, 21(3), e457-465. doi: 10.3747/co.21.1865
Snyder, C. F., Frick, K. D., Blackford, A. L., Herbert, R. J., Neville, B. A., Carducci, M. A., & Earle, C. C. (2010). How does initial treatment choice affect short-term and long-term costs for clinically localized prostate cancer? Cancer, 116(23), 5391-5399. doi: 10.1002/cncr.25517