News | Prostate Cancer | November 23, 2015

UCLA Researchers Find a Wide Variation in Costs to Treat Low-risk Prostate Cancer

How much does it actually cost to treat low-risk prostate cancer?

Photo courtesy of Elekta

Now, for the first time, UCLA researchers have described cost across an entire care process for low-risk prostate cancer – from the time a patient checks in for his first appointment to his post-treatment follow-up testing - using time-driven activity-based costing. And they found a wide variation in costs for the various available treatments that remained consistent over a 12-year period, indicating a better method to monitor costs could save valuable healthcare dollars, said study first author Aaron Laviana, M.D., a fifth year urology resident.

“This is the first study to truly investigate the costs of various treatments for prostate cancer over the long-term. As we move from traditional fee-for-service reimbursement models to accountable care organizations and bundled payments to curb growing health care expenditures, understanding the true costs of health care is essential,” Laviana said. “Traditional costing methods often lack transparency and can be arbitrary, preventing the true costs of a disease or treatment from being understood. This is important, as patients often receive a hospital bill with arbitrary charges that may or may not reflect their true treatment costs. This costing methodology creates an algorithm that allows organizations to assess their costs and see where they may be able to improve. Altogether, by maintaining similar quality, this will improve the overall value of care delivered.”

The study appears Nov. 2, 2015 in the peer-reviewed journal Cancer.

Laviana said the biggest surprise uncovered by the analysis was the relatively low cost of active surveillance, which uses repeated PSA testing and prostate biopsies to monitor for development of more aggressive disease in younger, healthier patients who might benefit from delaying treatment. Active surveillance costs remained low, even when they factored in the fact that 30 to 50 percent of patients eventually opt out and choose a definitive treatment.

At five years out from diagnosis, active surveillance still remained slightly less expensive than the price of robotic prostatectomy. Active surveillance is an important option to consider for low-risk prostate cancer, Laviana said, given many men who have it are more likely to die from other causes. It also avoids the complications from the traditional treatments of radiation and surgery, including difficulty urinating and problems with erection dysfunction.

Specifically, Laviana found costs ranging from $7,298 for active surveillance to $23,565 for intensity-modulated radiation therapy (IMRT), or conventional radiation therapy that is delivered in relatively small doses over eight weeks with patients receiving daily treatments during the process. The study also found that low-dose rate brachytherapy, the insertion of small permanent radioactive seeds into the prostate, at $8,978, was notably less expensive than high-dose rate brachytherapy, the insertion of higher dose temporary seeds, at $11,448.  Stereotactic body radiation therapy at $11,665 was notably less expensive than IMRT, with the savings attributable to shorter procedure times and markedly fewer visits required for stereotactic body radiation.

In robotic-assisted laparoscopic prostatectomy, both equipment costs and an inpatient stay at $2,306 contributed to its high cost of $16,946. Cryotherapy, or freezing the tumor, at $11,215 was more costly than low-dose rate brachytherapy, largely because of increased single-use equipment costs of $6,292 versus $1,869 for brachytherapy.

“We were surprised in the profound cost differences in radiation therapy based solely on the number of treatments delivered,” Laviana said. “Future studies are needed to determine whether there are differences in outcomes between these modalities.”

For this study, the team determined space and product costs and calculated personnel capacity cost rates. They calculated personnel costs for the prostate cancer treatment team of doctors, nurses and patient affairs based on the steps of the process. Space and equipment costs also were defined.

Going forward, the UCLA team plans to link the costing analysis to rigorously assessed quality measurements and outcomes trials to see which treatments provide the greatest value. They also plan to expand this study to assessing all levels of prostate cancer to see how the cost of care varies with localized high-risk prostate cancer as well as metastatic disease to analyze the burden of prostate cancer on end-of-life care.

The study was funded by the H & H Lee Surgical Research Scholar Program.

“The use of time-driven activity-based costing is feasible for analyzing cancer services and provides insights into cost-reduction tactics in an era focused on emphasizing value,” the study states. “By detailing all steps from diagnosis and treatment through 12 years of follow-up for low-risk prostate cancer, this study has demonstrated significant cost variation between competing treatments.”

For more information: http://urology.ucla.edu/

Related Content

Gadolinium-enhanced MRI of a cardiac radiation therapy patient at baseline (left) and 3 months post-treatment (right). Top: the left ventricle with patchy, gadolinium-enhanced scar was transmurally targeted with a radiation ose of 25 Gy between 3 and 6 o’clock (red brackets). Nonenhanced, remote myocardium is adjacent to target region (white arrowhead). Bottom: surviving nonenhanced myocardium within the same images is visible in the targeted region at baseline and 3 months post-treatment (yellow outline).

Gadolinium-enhanced MRI of a cardiac radiation therapy patient at baseline (left) and 3 months post-treatment (right). Top: the left ventricle with patchy, gadolinium-enhanced scar was transmurally targeted with a radiation ose of 25 Gy between 3 and 6 o’clock (red brackets). Nonenhanced, remote myocardium is adjacent to target region (white arrowhead). Bottom: surviving nonenhanced myocardium within the same images is visible in the targeted region at baseline and 3 months post-treatment (yellow outline). See more figures from this study.

Feature | Radiation Therapy | September 28, 2021
September 28, 2021 — New research from Washington University School of Medicine in St.
The global radiotherapy devices market is expected to grow from $5.44 billion in 2020 to $5.848 billion in 2021 at a compound annual growth rate (CAGR) of 7.5%

Varian's Ethos artificial intelligence radiotherapy device.

News | Radiation Oncology | September 28, 2021
September 28, 2021 — The global radiotherapy devices market is expected to grow from $5.44 billion in 2020 to $5.848
Scientists have identified two subtypes of metastatic prostate cancer that respond differently to treatment, information that could one day guide physicians in treating patients with the therapies best suited to their disease.

Getty Images

News | Prostate Cancer | September 24, 2021
September 24, 2021 — Scientists have identified two subtypes of metastatic...
Owkin, a startup that deploys artificial intelligence (AI) and Federated Learning technologies to augment medical research and enable scientific discoveries, presented findings in Hepatocellular Carcinoma (HCC) with Cleveland Clinic at the 2021 European Society of Medical Oncology (ESMO) conference.

Illustration courtesy of Cleveland Clinic

News | Artificial Intelligence | September 24, 2021
September 24, 2021 — Owkin, a startup that deploys...
The "Global Surface Guided Radiation Therapy (SGRT) Devices Market, By Device Type (Portable v/s Fixed), By Application (Breast Cancer, Head & Neck Cancer, Abdominal & Pelvic Cancer, Dermatology, Others), By End User, By Region, Competition Forecast & Opportunities, 2026" report

Image courtesy of Varian

News | Radiation Therapy | September 24, 2021
September 24, 2021 — The ...
The National Cancer Institute announced that Virginia Commonwealth University Massey Cancer Center, Medical University of South Carolina Hollings Cancer Center and City of Hope Comprehensive Cancer Center secured a highly competitive Specialized Program of Research Excellence (SPORE) grant that aims to address lung cancer racial disparities through precision medicine, targeted smoking cessation programs and community outreach.

VCU Massey Cancer Center director and SPORE principal investigator Dr. Robert Winn explains how this grant will help combat racial inequities in lung cancer. Image courtesy of VCU Massey Cancer Center

News | Lung Imaging | September 23, 2021
September 23, 2021 — The National Cancer Institute announced tha
The development of new research guidelines for interventional oncology that standardize treatment outcomes and the reporting of data represents a major step forward for an increasingly important medical subspecialty, according to a report in Radiology.

Getty Images

News | Radiation Oncology | September 21, 2021
September 21, 2021 — The development of new research guidelines for interventional oncology that standardize treatmen
Non-oncology doctors’ knowledge of oncology is frequently not up to date, with risks in the communication with patients  

Getty Images

News | Radiation Oncology | September 20, 2021
September 20, 2021 — The rapid pace of developments in the oncology field, mainly brought by cancer immunotherapy, me
IBA (Ion Beam Applications S.A., EURONEXT), a world leader in particle accelerator technology, and SCK CEN (Belgian Nuclear Research Center) announced a strategic R&D partnership to enable the production of Actinimum-225 (225Ac), a novel radioisotope which has significant potential in the treatment of cancer.
News | Radiation Oncology | September 17, 2021
September 17, 2021 — IBA (Ion Beam Applications S.A., EURONEXT), a world leader in particle accelerator technology, a