Cost Comparison Between Watchful Waiting With Active Surveillance and Active Treatment of Clinically Localized Prostate Cancer REPLY
ABSTRACT 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.
- SourceAvailable from: Heather Orom
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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)  . 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    . "
ABSTRACT: With growing evidence that some men with prostate cancer (PCa) may be overtreated, clinicians need greater knowledge of the factors that influence uptake of treatment recommendations in general, and specifically, uptake of active surveillance in patients for whom this is an appropriate treatment option. The objective of this study was to test the role of the quality of the physician-patient relationship in the choice to be followed by active surveillance, rather than receive definitive therapy (e.g., surgery and radiation). We hypothesized that patients would have been more influenced by their physicians' treatment recommendations to the degree that they held more positive perceptions of their relationship with their physicians, independent of treatment recommended.Urologic Oncology 12/2013; 32(4). DOI:10.1016/j.urolonc.2013.09.018 · 3.36 Impact Factor
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ABSTRACT: A fast ALC amplifier for burst-to-burst amplitude equalization in Satellite Communication TDMA is described. Some considerations are also provided concerning the definition of the optimum loop bandwidth in actual systems.
Article: Surgery for Prostate Cancer05/2011; 88(3).