Cost Comparison Between Watchful Waiting With Active Surveillance and Active Treatment of Clinically Localized Prostate Cancer REPLY

Department of Health Policy & Management, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Urology (Impact Factor: 2.19). 04/2010; 76(3):703-7. DOI: 10.1016/j.urology.2009.12.071
Source: PubMed


In part because of concern regarding overtreatment in men with prostate cancer, watchful waiting with active surveillance (WWAS) has been increasingly used in men diagnosed with low-risk prostate cancer. The present study investigates the difference in costs between men with low-risk prostate cancer treated with up-front radical prostatectomy (RP) versus WWAS.
A cost model was constructed using data from centers that have published their results in men who were followed up with WWAS compared with the actual costs of up-front RP calculated from a high volume center. Two WWAS arms of 15-year duration were created in which the follow-up protocol and conversion rate to active treatment were varied.
The cost of up-front RP including costs of surgery, complications, and follow up for 15 years was $15 235 per person. Costs of WWAS were estimated using annual conversion rates from WWAS to RP of both 5% and 7%. Costs per person in the WWAS arms ranged from $6558 to $11 992 in the scenarios created which represent a 43%-78.7% reduction in costs when compared with men undergoing up-front RP.
Watchful waiting with active surveillance is being increasingly used in hopes of decreasing the potential overtreatment of prostate cancer in men with low-risk disease. The present study suggests that WWAS is likely to markedly decrease costs when compared with active treatment with RP.

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    • "Historically, fewer than 10% of patients with prostate cancer (PCa) have been followed with watchful waiting or active surveillance, rather than being treated with definitive therapy (typically prostatectomy, external beam radiation, or brachytherapy) [1] [2]. There is growing consensus that this number is inappropriately low as evidence indicates that some patients with PCa have been overtreated, resulting in unnecessary decrements in the quality of patients' lives and increased financial cost [1] [2] [3] [4]. "
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    ABSTRACT: Any discussion of the future of medicine should include a discussion of prostate cancer surgery, which is presently one of the most rapidly evolving and technologically advanced areas of medicine. Prostate cancer is the most common cancer in men for which the surgical treatment is radical prostatectomy (RP). RP affords a high chance of cure for localized prostate cancer and has a demonstrated survival benefit. RP has been around for more than a century and has undergone a dramatic evolution culminating in modern techniques that allow for excellent oncologic control and quality of life. A variety of surgical approaches exist for RP including open, laparoscopic, and laparoscopic with robotic assistance. Outcomes, cost, learning curves and usage trends for these approaches are discussed. Conservative options that may precede surgery are also discussed.
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