Kohan A D, Armenakas N A, Fracchia J A
Section of Urology, Lenox Hill Hospital, New York, New York, USA.
J Urol. 2000 Feb;163(2):511-4.
We compare the comprehensive 1-year charges in a consecutive group of patients undergoing radical prostatectomy and transperineal interstitial brachytherapy for clinically localized prostate cancer at a single urban institution.
A total of 60 consecutive men with clinically localized prostate cancer (T1-T2, N0, M0) were treated during a 15-month period with radical prostatectomy or interstitial brachytherapy. Hospital and outpatient records were analyzed for each patient in regard to preoperative, operative and postoperative charges. Parameters included number of encounters, diagnostic and therapeutic interventions, hospitalization and operative charges, and followup visits, diagnostic tests and interventions for 1 year. All charge calculations were based arbitrarily on the 1996 Medicare fee schedule, factoring in the mandated global charge reimbursement period of 90 days for both procedures.
Of the patients 38 underwent radical prostatectomy (prostatectomy group) and 22 underwent interstitial brachytherapy (brachytherapy group). The brachytherapy group was older with higher pretreatment serum prostate specific antigen and clinical stage disease, and more frequently received neoadjuvant hormonal therapy compared to the prostatectomy group. The 2 groups were similar in Gleason score and, when applicable, duration of neoadjuvant hormonal therapy. Preoperative charges were 15.3% lower for prostatectomy than for brachytherapy (not statistically significant). Conversely, operative charges for prostatectomy were 13.5% higher (p = 0.04). The major difference among preoperative, operative and postoperative charges was for those incurred postoperatively by the brachytherapy group, which were 56.0% higher than those for the prostatectomy group ($2,285.20 versus $1,007.20, p = 0.0004).
Transperineal interstitial seed implantation is perceived by many as more cost-effective than radical prostatectomy for patients with clinically localized prostate cancer. We demonstrated that when such patients were followed for 1 year, the comprehensive charges for radical prostatectomy and interstitial brachytherapy were equivalent.
我们比较了在一家城市机构中，一组连续接受根治性前列腺切除术和经会阴间质近距离放射治疗的临床局限性前列腺癌患者的1年综合费用。
在15个月期间，共有60例连续的临床局限性前列腺癌（T1-T2，N0，M0）男性患者接受了根治性前列腺切除术或间质近距离放射治疗。分析了每位患者的医院和门诊记录，包括术前、手术中和术后费用。参数包括就诊次数、诊断和治疗干预、住院和手术费用，以及1年的随访就诊、诊断检查和干预。所有费用计算均基于1996年医疗保险费用表，同时考虑到两种手术规定的90天全球费用报销期。
患者中38例行根治性前列腺切除术（前列腺切除术组），22例行间质近距离放射治疗（近距离放射治疗组）。与前列腺切除术组相比，近距离放射治疗组年龄更大，治疗前血清前列腺特异性抗原水平更高，临床分期疾病更严重，且更频繁接受新辅助激素治疗。两组在 Gleason 评分以及适用时新辅助激素治疗持续时间方面相似。前列腺切除术的术前费用比近距离放射治疗低15.3%（无统计学意义）。相反，前列腺切除术的手术费用高13.5%（p = 0.04）。术前、手术中和术后费用的主要差异在于近距离放射治疗组术后产生的费用，比前列腺切除术组高56.0%（2285.20美元对1007.20美元，p = 0.0004）。
对于临床局限性前列腺癌患者，许多人认为经会阴间质粒子植入比根治性前列腺切除术更具成本效益。我们证明，当对这些患者进行1年随访时，根治性前列腺切除术和间质近距离放射治疗的综合费用相当。
