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Cost Expenditures for Active Surveillance Versus Active Treatments For Localized Prostate Cancer
Rebecca S. Lavelle, MD1, Stephen B. Williams, MD1, Jim C. Hu, MD2, Kevin R. Loughlin, MD1.
1Brigham and Women's Hospital, Division of Urologic Surgery, Boston, MA, USA, 2Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital, Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Boston, MA, USA.

BACKGROUND:
Active surveillance versus definitive treatments for localized prostate cancer is underutilized. We sought to estimate cost expenditures for active surveillance versus treatment in order to discern whether there is a cost benefit associated with active surveillance.
METHODS:
We used the Klotz active surveillance protocol in order to estimate Medicare cost expenditures for active surveillance for localized prostate cancer. Medicare reimbursement fees were derived from the Current Procedural Terminology (CPT) codes assigned to each of the follow up criteria defined in the Klotz active surveillance protocol. The follow up criteria include the following: PSA every 3 months for 2 years, PSA every 6 months after 2 years, DRE every 3 months for 2 years, DRE every 6 months after 2 years, ultrasound guided prostate needle biopsy 6-12 months after diagnosis, and repeat ultrasound guided prostate needle biopsy 3-4 years after diagnosis. The total cost expenditure was calculated at one and five years after diagnosis. We used previously published literature regarding cost expenditures for radical prostatectomy, external beam radiation and brachytherapy treatments. The published literature included estimated cost expenditures from the CaPSURE database (1995-2004), SEER Medicare database (1991-1999), and Health Care Financial Administration public use files (1993-1996).
RESULTS:
The Medicare cost expenditure of active surveillance was estimated to be $1,781 and $3,390 at one and five years after diagnosis, respectively. For the 6 month period after diagnosis/treatment, the cost expenditure of radical prostatectomy ranged from $12,184-$19,019. The cost expenditure of external beam radiation ranged from $10,996-$24,204, whereas brachytherapy ranged from $7,588-$15,301.
CONCLUSIONS:
Active surveillance is an underutilized management option for patients with low-risk, localized prostate cancer. We found current active surveillance cost expenditures to be approximately four to five times less than that of current treatment options.


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