Burkhardt Jeffrey H, Litwin Mark S, Rose Christopher M, Correa Roy J, Sunshine Jonathan H, Hogan Christopher, Hayman James A
Research Department, American College of Radiology, Reston, VA, USA.
J Clin Oncol. 2002 Jun 15;20(12):2869-75. doi: 10.1200/JCO.2002.11.136.
Radical prostatectomy and external-beam radiation are the most common treatments for localized prostate cancer. Given the absence of clinical consensus in favor of one treatment or the other, relative costs may be a significant factor. This study compares the direct medical costs during the month before and 9 months after diagnosis for patients treated primarily with external-beam radiation or radical prostatectomy for early-stage prostate cancer.
Patients age 65 or older and coded by the Surveillance, Epidemiology, and End Results (SEER) registry as having been diagnosed with adenocarcinoma of the prostate treated primarily with external-beam radiation or radical prostatectomy during 1992 and 1993 were identified. The initial treatment costs, as measured by Medicare-approved payment amounts, for each strategy were analyzed using linked SEER-Medicare claims data after adjusting for differences in comorbidity and age. An intent-to-treat analysis was also performed to adjust for differences in staging between the two groups.
For patients in the treatment-received analysis, the average costs were significantly different; $14,048 (95% confidence interval [CI], $13,765 to $14,330) for radiation therapy and $17,226 (95% CI, $16,891 to $17,560) for radical prostatectomy (P <.001). The average costs for patients in the intent-to-treat analysis were also significantly less for radiation therapy patients ($14,048; 95% CI, $13,765 to $14,330) than for those who underwent radical prostatectomy ($17,516; 95% CI, $17,195 to $17,837; P <.001).
For patients with early-stage prostate cancer, average costs during the initial treatment interval were at least 23% greater for radical prostatectomy than for external-beam radiation. Major limitations of the research include not studying costs after the initial treatment interval and questionable current applicability, given changes in management of early prostate cancer.
根治性前列腺切除术和外照射放疗是局限性前列腺癌最常见的治疗方法。鉴于在支持一种治疗方法而非另一种治疗方法上缺乏临床共识，相对成本可能是一个重要因素。本研究比较了主要接受外照射放疗或根治性前列腺切除术治疗的早期前列腺癌患者在诊断前一个月和诊断后9个月期间的直接医疗成本。
确定年龄在65岁及以上、由监测、流行病学和最终结果（SEER）登记处编码为在1992年和1993年期间主要接受外照射放疗或根治性前列腺切除术治疗的前列腺腺癌患者。在调整合并症和年龄差异后，使用链接的SEER - 医疗保险索赔数据分析每种策略的初始治疗成本（以医疗保险批准的支付金额衡量）。还进行了意向性治疗分析，以调整两组之间分期的差异。
在接受治疗分析的患者中，平均成本有显著差异；放疗的平均成本为14,048美元（95%置信区间[CI]，13,765美元至14,330美元），根治性前列腺切除术的平均成本为17,226美元（95%CI，16,891美元至17,560美元）（P <.001）。在意向性治疗分析中，放疗患者的平均成本（14,048美元；95%CI，13,765美元至14,330美元）也显著低于接受根治性前列腺切除术的患者（17,516美元；95%CI，17,195美元至17,837美元；P <.001）。
对于早期前列腺癌患者，根治性前列腺切除术在初始治疗期间的平均成本比外照射放疗至少高23%。该研究的主要局限性包括未研究初始治疗期后的成本，以及鉴于早期前列腺癌管理的变化，目前的适用性存疑。
