Department of Urologic Surgery, Vanderbilt University, Nashville, TN, USA.
Cancer. 2012 Jul 15;118(14):3512-8. doi: 10.1002/cncr.26688. Epub 2011 Dec 16.
The costs associated with a contemporary active surveillance strategy compared with immediate treatment for prostate cancer are not well characterized. The purpose of this study is to elucidate the health care costs of an active surveillance paradigm for prostate cancer.
A theoretical cohort of 120,000 men selecting active surveillance for prostate cancer was created. The number of men remaining on active surveillance and those exiting to each of 5 treatments over 5 years were simulated in a Markov model. Estimated total costs after 5 years of active surveillance with subsequent delayed treatment were compared with immediate treatment. Sensitivity analyses were performed to test the effect of various surveillance strategies and attrition rates. Additional analyses to include 10 years of follow-up were performed.
The average simulated cost of treatment for 120,000 men initiating active surveillance with 5 years of follow-up and subsequent delayed treatment resulted in per patient cost savings of $16,042 (95% confidence interval [CI], $16,039-$16,046) relative to initial curative treatment. This represents a $1.9 billion dollar savings to the cohort. The strict costs of active surveillance exceeded those of brachytherapy in the ninth year of follow-up. A yearly biopsy within the active surveillance cohort increased costs by 22%, compared with every other year biopsy. At 10 years of follow-up, active surveillance still resulted in a cost benefit; however, the savings were reduced by 38% to $9944 (95% CI, $9941-$9948) per patient relative to initial treatment.
These data demonstrate that active surveillance represents a considerable cost savings over immediate treatment for prostate cancer in a theoretical cohort after 5 and 10 years of follow-up.
与前列腺癌的即时治疗相比，当代主动监测策略相关的成本尚不清楚。本研究旨在阐明前列腺癌主动监测范式的医疗保健成本。
创建了一个理论队列，由 120000 名男性选择前列腺癌主动监测。在一个马尔可夫模型中模拟了 5 年内仍处于主动监测状态并退出 5 种治疗方法的男性数量。将 5 年主动监测后延迟治疗的估计总费用与即时治疗进行了比较。进行了敏感性分析，以测试各种监测策略和淘汰率的影响。进行了额外的分析，包括 10 年的随访。
120000 名男性开始接受主动监测，随访 5 年并随后延迟治疗，平均模拟治疗费用为每位患者节省 16042 美元（95%置信区间[CI]，16039-16046）相对于初始治愈性治疗。这代表该队列节省了 19 亿美元。在第 9 年的随访中，主动监测的严格成本超过了近距离放射治疗。在主动监测队列中每年进行一次活检会使成本增加 22%，而每两年进行一次活检则会使成本增加 22%。在 10 年的随访中，主动监测仍然具有成本效益；然而，与初始治疗相比，每位患者的节省额减少了 38%，为 9944 美元（95%CI，9941-9948）。
这些数据表明，在理论队列中，与前列腺癌的即时治疗相比，主动监测在 5 年和 10 年后随访时具有相当大的成本节约。
