Prostate Cancer
Prostate cancer is a prevalent cancer type that affects men globally. It represents around 26% of all male cancers in the US and Europe, with 34,130 prostate cancer-related deaths recorded in the US in 2021 (1). In addition to the human cost, the economic impact of managing prostate cancer is significant, with an estimated expenditure of $9.862 billion in the US in 2006. The costs related to managing prostate cancer can vary widely based on the patient's risk group and treatment approach (2).
Early Detection Can Reduce Economic Burden
In a recent study, the costs of managing prostate cancer for a US commercial health plan over 10 years were estimated based on the current treatment paradigm and associated cost of care. The findings revealed that the 10-year costs for low-, intermediate-, and high-risk patients were $45,957, $99,445, and $188,928, respectively (1). Early detection of prostate cancer and active surveillance are effective strategies that can help decrease these costs.
The clinical paradigm used reflected the current standard of practice: How initial patient management was approached differed depending on the patient's AUA (American Urological Association) risk group. For the AUA low-risk group, 24% of patients were managed using active surveillance (AS) initially, whereas 76% received single-modality therapy. In the AUA intermediate-risk group, 4% were initially managed using AS, 79% with single-modality therapy, and 17% with multimodality therapy. For the AUA high-risk group, 81% received single-modality therapy, and 19% received multimodality therapy (1).
Active Surveillance is Less Expensive
Active surveillance was found to be less expensive than definitive treatment for intermediate-risk patients, despite their higher failure rates. The study showed that 10-year costs per patient were $90,614 and $99,394 for AS and definitive treatment, respectively (1). Thus, AS can be an effective management strategy for low- and intermediate-risk prostate cancer patients, leading to a reduction in the economic burden associated with prostate cancer management.
In addition, it was discovered that from years 4 to 10, the costs incurred by high-risk patients were substantially higher. This can be attributed to the fact that high-risk patients are more likely to transition to therapies that are more expensive, such as salvage RT ($29,101 per year) and castration-resistant prostate cancer (CRPC) ($122,323 per year) (1). This emphasizes the significance of timely detection of prostate cancer and active surveillance to minimize the likelihood of progression to higher-risk disease and the accompanying financial strain.
At year 5, active surveillance was found to be cost-saving compared to radical prostatectomy and radiation therapy, according to a separate study. For low-risk patients, initial treatment with ADT resulted in the lowest costs, but it is not commonly used as a first-line therapy. Taking into account the distribution of low-risk patients receiving definitive treatments, this study suggests that using active surveillance can save up to $14,800 per patient at year 5 compared to those who receive definitive treatment (1) (3).
In conclusion, prostate cancer is a significant health and economic burden worldwide. However, the use of PSA testing and active surveillance has the potential to significantly reduce the economic burden associated with prostate cancer management. These tools can reduce the incidence of metastatic prostate cancer and help avoid costly treatments like salvage radiation therapy and castration-resistant prostate cancer. Therefore, healthcare providers and policymakers should consider the potential benefits of early detection and active surveillance when developing strategies for prostate cancer management.
Reference
(1) Gustavsen, G. et al. (2020) ‘Economic burden of illness associated with localized prostate cancer in the United States’, Future Oncology, 16(1), pp. 4265–4277. doi:10.2217/fon-2019-0639.
(2) Ellinger, J. et al. (2022) ‘Prostate cancer treatment costs increase more rapidly than for any other cancer—how to reverse the trend?’, EPMA Journal, 13(1), pp. 1–7. doi:10.1007/s13167-022-00276-3.
(3) The cost of metastatic prostate cancer in the United States. Available at: https://www.auajournals.org/doi/abs/10.1097/UPJ.0000000000000363 (Accessed: 12 May 2023).
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