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The Economics of Active Surveillance for Prostate Cancer

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Active Surveillance for Localized Prostate Cancer

Part of the book series: Current Clinical Urology ((CCU))

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Abstract

Purpose: To better understand the economic implications of managing low-risk prostate cancer with active surveillance (AS)

Recent Findings: The expenses of caring for men with prostate cancer are highly variable depending on treatment modality chosen. Costs are generally lowest with traditional watchful waiting and highest with radiation therapy. Compared to immediate treatment, active surveillance (AS) can result in a net-per-patient savings to a healthcare system. Prostate biopsy and routine office visits are the highest expenditure for men on AS, and increasing the frequency of prostate biopsy will reduce the cost-effectiveness of this approach. The cost-effectiveness of AS is also highly sensitive to the number of men progressing to receive additional treatments for prostate cancer over time. New technology and regulations are also impacting the cost-benefit of AS in ways yet to be defined.

Summary: AS represents a cost-effective strategy for managing low-risk prostate cancer as the majority of men remain without additional and often costly treatment. The economic impact of the approach will evolve in the coming years, depending on technologic costs and regulatory changes to payments for health services rendered.

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References

  1. Bruinsma SM, Bangma CH, Carroll PR, Leapman MS, Rannikko A, Petrides N, et al. Active surveillance for prostate cancer: a narrative review of clinical guidelines. Nat Rev Urol. 2016;13(3):151–67.

    Article  CAS  PubMed  Google Scholar 

  2. Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010–2020. J Natl Cancer Inst. 2011;103(2):117–28.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Torre LA, Siegel RL, Ward EM, Jemal A. Global cancer incidence and mortality rates and trends–an update. Cancer Epidemiol Biomarkers Prev Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol. 2016;25(1):16–27.

    Article  Google Scholar 

  4. Skolarus TA, Zhang Y, Miller DC, Wei JT, Hollenbeck BK. The economic burden of prostate cancer survivorship care. J Urol. 2010;184(2):532–8.

    Article  PubMed  Google Scholar 

  5. DeSantis CE, Lin CC, Mariotto AB, Siegel RL, Stein KD, Kramer JL, et al. Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin. 2014;64(4):252–71.

    Article  PubMed  Google Scholar 

  6. Kitazawa T, Matsumoto K, Fujita S, Seto K, Hanaoka S, Hasegawa T. Cost of illness of the prostate cancer in Japan–a time-trend analysis and future projections. BMC Health Serv Res. 2015;15:453.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Global Burden of Disease Cancer C, Fitzmaurice C, Dicker D, Pain A, Hamavid H, Moradi-Lakeh M, et al. The global burden of cancer 2013. JAMA Oncol. 2015;1(4):505–27.

    Article  Google Scholar 

  8. Nguyen PL, Gu X, Lipsitz SR, Choueiri TK, Choi WW, Lei Y, et al. Cost implications of the rapid adoption of newer technologies for treating prostate cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2011;29(12):1517–24.

    Article  Google Scholar 

  9. Yabroff KR, Lund J, Kepka D, Mariotto A. Economic burden of cancer in the United States: estimates, projections, and future research. Cancer Epidemiol Biomark Prev. 2011;20(10):2006–14.

    Article  Google Scholar 

  10. Wilson LS, Tesoro R, Elkin EP, Sadetsky N, Broering JM, Latini DM, et al. Cumulative cost pattern comparison of prostate cancer treatments. Cancer. 2007;109(3):518–27.

    Article  PubMed  Google Scholar 

  11. Konski A, Speier W, Hanlon A, Beck JR, Pollack A. Is proton beam therapy cost effective in the treatment of adenocarcinoma of the prostate? J Clin Oncol. 2007;25(24):3603–8.

    Article  PubMed  Google Scholar 

  12. Molinier L, Castelli C, Bauvin E, Rebillard X, Soulie M, Daures JP, et al. Cost study of the clinical management of prostate cancer in France: results on the basis of population-based data. Eur J Health Econ. 2011;12(4):363–71.

    Article  PubMed  Google Scholar 

  13. Perlroth DJ, Goldman DP, Garber AM. The potential impact of comparative effectiveness research on U.S. health care expenditures. Demography. 2010;47(Suppl):S173–90.

    Article  PubMed  Google Scholar 

  14. Kommu SS, Eden CG, Luscombe CJ, Golash A, Persad RA. Initial treatment costs of organ-confined prostate cancer: a general perspective. BJU Int. 2011;107(1):1–3.

    Article  PubMed  Google Scholar 

  15. Snyder CF, Frick KD, Blackford AL, Herbert RJ, Neville BA, Carducci MA, et al. How does initial treatment choice affect short-term and long-term costs for clinically localized prostate cancer? Cancer. 2010;116(23):5391–9.

    Article  PubMed  Google Scholar 

  16. Dall’Era MA, Cooperberg MR, Chan JM, Davies BJ, Albertsen PC, Klotz LH, et al. Active surveillance for early-stage prostate cancer: review of the current literature. Cancer. 2008;112(8):1650–9.

    Article  PubMed  Google Scholar 

  17. Aizer AA, Gu X, Chen MH, Choueiri TK, Martin NE, Efstathiou JA, et al. Cost implications and complications of overtreatment of low-risk prostate cancer in the United States. J Natl Compr Cancer Netw JNCCN. 2015;13(1):61–8.

    Article  PubMed  Google Scholar 

  18. Redelmeier DA. Understanding patients’ decisions. JAMA. 1993;270(1):72.

    Article  CAS  PubMed  Google Scholar 

  19. Weiner AB, Conti RM, Eggener SE. National economic conditions and patient insurance status predict prostate cancer diagnosis rates and management decisions. J Urol. 2016;195(5):1383–9.

    Article  PubMed  Google Scholar 

  20. Roth JA, Gulati R, Gore JL, Cooperberg MR, Etzioni R. Economic analysis of prostate-specific antigen screening and selective treatment strategies. JAMA Oncol. 2016;2(7):890–8.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Keegan KA, Dall’Era MA, Durbin-Johnson B, Evans CP. Active surveillance for prostate cancer compared with immediate treatment: an economic analysis. Cancer. 2012;118(14):3512–8.

    Article  PubMed  Google Scholar 

  22. Dall’Era MA, Konety BR, Cowan JE, Shinohara K, Stauf F, Cooperberg MR, et al. Active surveillance for the management of prostate cancer in a contemporary cohort. Cancer. 2008;112(12):2664–70.

    Article  PubMed  Google Scholar 

  23. Dragomir A, Cury FL, Aprikian AG. Active surveillance for low-risk prostate cancer compared with immediate treatment: a Canadian cost comparison. CMAJ Open. 2014;2(2):E60–8.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Sanyal C, Aprikian AG, Cury FL, Chevalier S, Dragomir A. Management of localized and advanced prostate cancer in Canada: a lifetime cost and quality-adjusted life-year analysis. Cancer. 2016;122(7):1085–96.

    Article  PubMed  Google Scholar 

  25. Dall’Era MA, Albertsen PC, Bangma C, Carroll PR, Carter HB, Cooperberg MR, et al. Active surveillance for prostate cancer: a systematic review of the literature. Eur Urol. 2012;62(6):976–83.

    Article  PubMed  Google Scholar 

  26. Klotz L, Vesprini D, Sethukavalan P, Jethava V, Zhang L, Jain S, et al. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2015;33(3):272–7.

    Article  Google Scholar 

  27. Tosoian JJ, Mamawala M, Epstein JI, Landis P, Wolf S, Trock BJ, et al. Intermediate and longer-term outcomes from a prospective active-surveillance program for Favorable-risk prostate cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2015;33(30):3379–85.

    Article  Google Scholar 

  28. Albala D, Kemeter MJ, Febbo PG, Lu R, John V, Stoy D, et al. Health economic impact and prospective clinical utility of Oncotype DX® GPS. Rev Urol. 2016;18(3):123–32. in press

    PubMed  PubMed Central  Google Scholar 

  29. Cerantola Y, Dragomir A, Tanguay S, Bladou F, Aprikian A, Kassouf W. Cost-effectiveness of multiparametric magnetic resonance imaging and targeted biopsy in diagnosing prostate cancer. Urol Oncol. 2016;34(3):119.e1–9.

    Article  Google Scholar 

  30. Walton Diaz A, Shakir NA, George AK, Rais-Bahrami S, Turkbey B, Rothwax JT, et al. Use of serial multiparametric magnetic resonance imaging in the management of patients with prostate cancer on active surveillance. Urol Oncol. 2015;33(5):202.e1–7.

    Article  Google Scholar 

  31. Obama B. United States Health Care Reform: progress to date and next steps. JAMA. 2016;316(5):525–32.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Yuh L, Dall’era M, Penson DF, Evans CP. Active surveillance for prostate cancer under the patient protection and affordable care act. Urol Pract. 2015;2(4):154–9.

    Article  Google Scholar 

  33. Keegan KA, Penson DF. The patient protection and affordable care act: the impact on urologic cancer care. Urol Oncol Semin Orgin Invest. 2013;31(7):980–4.

    Article  Google Scholar 

  34. Thomsen FB, Berg KD, Roder MA, Iversen P, Brasso K. Active surveillance for localized prostate cancer: an analysis of patient contacts and utilization of healthcare resources. Scand J Urol. 2015;49(1):43–50.

    Article  PubMed  Google Scholar 

  35. Song Z, Colla CH. Specialty-based global payment: a new phase in payment reform. JAMA. 2016;315(21):2271–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Loeb S, Carter HB, Berndt SI, Ricker W, Schaeffer EM. Is repeat prostate biopsy associated with a greater risk of hospitalization? Data from SEER-Medicare. J Urol. 2012;189(3):867–70.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Jayadevappa R, Schwartz JS, Chhatre S, Gallo JJ, Wein AJ, Malkowicz SB. The burden of out-of-pocket and indirect costs of prostate cancer. Prostate. 2010;70(11):1255–64.

    Article  PubMed  Google Scholar 

  38. McCombie SP, Hawks C, Emery JD, Hayne D. A ‘one stop’ prostate clinic for rural and remote men: a report on the first 200 patients. BJU Int. 2015;116:11–7.

    Article  PubMed  Google Scholar 

  39. Hayes JH, Ollendorf DA, Pearson SD, Barry MJ, Kantoff PW, Lee PA, et al. Observation versus initial treatment for men with localized, low-risk prostate cancer: a cost-effectiveness analysis. Ann Intern Med. 2013;158(12):853–60.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, University of California, Davis, Sacramento, CA, USA

    Robert B. Lurvey & Marc A. Dall’Era

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  1. Robert B. Lurvey
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  2. Marc A. Dall’Era
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Correspondence to Marc A. Dall’Era .

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  1. University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

    Laurence Klotz

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Lurvey, R.B., Dall’Era, M.A. (2018). The Economics of Active Surveillance for Prostate Cancer. In: Klotz, L. (eds) Active Surveillance for Localized Prostate Cancer. Current Clinical Urology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-62710-6_20

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  • DOI: https://doi.org/10.1007/978-3-319-62710-6_20

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  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-319-62709-0

  • Online ISBN: 978-3-319-62710-6

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