Radiation Oncology/Prostate/Utilization

Prostate Therapy Utilization

Utilization

• Center for Disease Control (CDC), Atlanta; 2007 PMID 17469027 -- "Use of additional treatment for prostate cancer after radical prostatectomy, radiation therapy, androgen deprivation, or watchful waiting." (Berge V, Scand J Urol Nephrol. 2007;41(3):198-203.)
  • SEER + Medicare claims data. 12,711 patients. Initial RP 31%, initial RT 31%, initial ADT 9%, initial WW 28%
  • Outcome: Initial RP: 8% additional RT, 12% additional ADT. Initial RT: 23% additional ADT. Initial WW: 22% additional ADT
  • Conclusion: If initially treated with RT or observation, more likely to receive ADT as follow-up treatment than if initially treated with RP

Costs

• American College of Radiology; 2002 (1992-1993) PMID 12065564 -- "Comparing the costs of radiation therapy and radical prostatectomy for the initial treatment of early-stage prostate cancer." (Burkhardt JH, J Clin Oncol. 2002 Jun 15;20(12):2869-75.)
  • Linked SEER-Medicare analysis.
  • Outcome: Costs RT $14,048 vs. RP $17,226 (SS)
  • Conclusion: For early-stage PCA, average costs were at least 23% greater for RP

• UCLA; 2000 (1993-1996) PMID 11042575 -- "A nationwide charge comparison of the principal treatments for early stage prostate carcinoma." (Brandeis J, Cancer. 2000 Oct 15;89(8):1792-9.)
  • HCFA claims data for inpatient, outpatient and Part B claims. 10,107 men with initial diagnosis of prostate cancer, treatment, +6 months of follow-up. RT 58%, brachy 7%, RP 35%. During the 4 years, RT decreased by 20%, brachy increased by 21%
  • Cost: RP + adjuvant RT $31,329 vs. RT + brachy boost $24,407 vs. RP $19,019 vs RT $15,937 vs brachy $15,301 (SS). Utilization varied with age, race, and geographic region
  • Outcome: Without clear survival advantage, costs, QoL and patient preference take on paramount importance

Proton Therapy

• Fox Chase; 2007 PMID 17704408 -- "Is proton beam therapy cost effective in the treatment of adenocarcinoma of the prostate?" (Konski A, J Clin Oncol. 2007 Aug 20;25(24):3603-8.)
  • Markov model. Cost-effectiveness evaluation of 91.8 CGE proton beam vs. 81 CGE photon IMRT, using cost, bNED, utility data
  • 15 year model: 70 year old: cost of protons $63,500 vs. IMRT $36,800; 60 year old: protons $65,000 vs. photons $39,400. Incremental cost/QALY 70-year old $63,6000 and 60-year old $55,700
  • Conclusion: Assuming 10 Gy additional dose-escalation, proton beam not cost-effective for most patients
  • Editorial PMID 17704400

• Oreboro; 2005 (Sweden) PMID 16332598 -- "The potential of proton beam radiation therapy in prostate cancer, other urological cancers and gynaecological cancers." (Johansson B, Acta Oncol. 2005;44(8):890-5.)
  • Estimate of the number of Swedish patients suitable for protons; annually ~300 prostate patients, ~50 GYN patients