Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA.
Cancer. 2010 Dec 1;116(23):5391-9. doi: 10.1002/cncr.25517. Epub 2010 Aug 23.
Data regarding costs of prostate cancer treatment are scarce. This study investigates how initial treatment choice affects short-term and long-term costs.
This retrospective, longitudinal cohort study followed prostate-cancer cases diagnosed in 2000 for 5 years using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Men age≥66 years, in Medicare fee for service, diagnosed with clinically localized prostate cancer in 2000 while residing in a SEER region, were matched to noncancer controls using age, sex, race, region, comorbidity, and survival. On the basis of treatment received during the first 9 months postdiagnosis, patients were assigned to watchful waiting, radiation, hormonal therapy, hormonal+radiation, and surgery (may have received other treatments). Incremental costs for prostate cancer were the difference in costs for prostate cancer cases versus matched controls. Costs were divided into initial treatment (months -1 to 12), long-term (each 12 months thereafter), and total (months -1 to 60). Sensitivity analyses excluded the last 12 months of life.
A total of 13,769 prostate-cancer cases were matched to 13,769 noncancer controls. Watchful waiting had the lowest initial treatment ($4270) and 5-year total costs ($9130). Initial treatment costs were highest for hormonal+radiation ($17,474) and surgery ($15,197). At $26,896, 5-year total costs were highest for hormonal therapy only followed by hormonal+radiation ($25,097) and surgery ($19,214). After excluding the last 12 months of life, total costs were highest for hormonal+radiation ($23,488) and hormonal therapy ($23,199).
Patterns of costs vary widely based on initial treatment. These data can inform patients and clinicians considering treatment options and policy makers interested in patterns of costs.
关于前列腺癌治疗费用的数据很少。本研究调查了初始治疗选择如何影响短期和长期成本。
本回顾性、纵向队列研究使用监测、流行病学和最终结果（SEER）-医疗保险数据库，对 2000 年诊断的前列腺癌病例进行了 5 年的随访。年龄≥66 岁、在医疗保险按服务收费制下、2000 年在 SEER 地区诊断为局限性前列腺癌、年龄、性别、种族、地区、合并症和生存情况相匹配的非癌症对照。根据诊断后前 9 个月接受的治疗，将患者分为观察等待、放疗、激素治疗、激素+放疗和手术（可能接受其他治疗）。前列腺癌的增量成本是前列腺癌病例与匹配对照的成本差异。成本分为初始治疗（月-1 至 12）、长期（此后每 12 个月）和总（月-1 至 60）。敏感性分析排除了生命的最后 12 个月。
共 13769 例前列腺癌病例与 13769 例非癌症对照相匹配。观察等待的初始治疗（4270 美元）和 5 年总费用（9130 美元）最低。激素+放疗（17474 美元）和手术（15197 美元）的初始治疗费用最高。激素治疗的 5 年总费用最高，为 26896 美元，其次是激素+放疗（25097 美元）和手术（19214 美元）。排除生命的最后 12 个月后，激素+放疗（23488 美元）和激素治疗（23199 美元）的总费用最高。
基于初始治疗，成本模式差异很大。这些数据可以为考虑治疗方案的患者和临床医生以及对成本模式感兴趣的政策制定者提供信息。
