Brandeis J, Pashos C L, Henning J M, Litwin M S
Departments of Urology and Health Services, University of California, Los Angeles, California, USA.
Cancer. 2000 Oct 15;89(8):1792-9.
The diagnosis and treatment of men with early stage prostate carcinoma is expensive and controversial, yet the similarities in reported survival rates has underscored the importance of ascertaining the relative charges of different forms of therapy.
Patient specific data on demographic characteristics, hospital and physician resource use, and charges were obtained from the Health Care Financing Administration for 1993 through 1996. The inpatient, outpatient, and part B claims from men with a new diagnosis of prostate carcinoma were captured from the quarter of the year in which biopsy was performed through the two quarters after treatment. Charges are reported in inflation-unadjusted dollars.
Of 10,107 men treated for early stage prostate carcinoma, 58% received external beam radiation therapy (XRT), 35% had radical prostatectomy, and 7% underwent brachytherapy. Over the 4 years, use of XRT decreased 19% whereas use of brachytherapy increased 21%. Men aged 65-69 years were more likely to have radical prostatectomy, but after age 70 years, XRT predominated. The most expensive treatments were radical prostatectomy with adjuvant XRT ($31,329) and brachytherapy with pretreatment XRT ($24,407). Cost of radical prostatectomy alone was more than XRT alone ($19,019 vs. 15,937; P < 0.05) or brachytherapy alone ($15,301; P < 0.05). Treatment utilization varied with age, race, and geographic region.
The mean charges for the workup, treatment, and 6 month follow-up of patients treated for early stage prostate carcinoma ranged between $15,301 and $31,329, with significant treatment group differences. Without a clear survival advantage from one form of treatment, issues such as costs, quality of life, and patient preferences take on paramount importance.
早期前列腺癌男性患者的诊断和治疗成本高昂且存在争议，但报告的生存率相似突出了确定不同治疗方式相对费用的重要性。
从医疗保健财务管理局获取了1993年至1996年患者的特定数据，包括人口统计学特征、医院和医生资源使用情况以及费用。从活检进行的年份季度到治疗后的两个季度，收集新诊断为前列腺癌男性的住院、门诊和B部分索赔。费用以未调整通货膨胀的美元报告。
在10107例接受早期前列腺癌治疗的男性中，58%接受了外照射放疗（XRT），35%进行了根治性前列腺切除术，7%接受了近距离放射治疗。在这4年中，XRT的使用减少了19%，而近距离放射治疗的使用增加了21%。65 - 69岁的男性更有可能进行根治性前列腺切除术，但70岁以后，XRT占主导地位。最昂贵的治疗是辅助XRT的根治性前列腺切除术（31329美元）和预处理XRT的近距离放射治疗（24407美元）。单纯根治性前列腺切除术的成本高于单纯XRT（19019美元对15937美元；P < 0.05）或单纯近距离放射治疗（15301美元；P < 0.05）。治疗利用率因年龄、种族和地理区域而异。
早期前列腺癌患者检查、治疗及6个月随访的平均费用在15301美元至31329美元之间，各治疗组之间存在显著差异。在一种治疗方式没有明显生存优势的情况下，成本、生活质量和患者偏好等问题变得至关重要。
