BOSTONRadical prostatectomies were consistently at least 16%
more expensive than radiation therapy in a study of 16,941 patients with
early-stage prostate cancer reported at the 42nd Annual Meeting of the American
Society for Therapeutic Radiology and Oncology (ASTRO) .
Jeffrey Burkhardt, PhD, assistant professor of health care
finance, University of Alabama at Birmingham, said that the average cost for
4,363 patients who received radiation therapy alone was $10,047. For 3,117
patients treated only with radical prostatectomy, it was $13,841 (P < .001).
The price difference persisted when combination therapies were
added to the review. For a group of 5,295 patients who received radiation
therapy either alone or in combination with prostate surgery other than radical
prostatectomy, the average cost was $11,226.
For a group of 3,198 patients who underwent radical
prostatectomies alone or with follow-up radiation therapy, the average cost was
SEER Database for 1992-1993
Dr. Burkhardt and his colleagues used information from the
Surveillance, Epidemiology, and End Results (SEER) Medicare database for the
years 1992 and 1993. This was the most recent information available when the
study was begun, he said.
All of the patients were age 65 and over with localized
adenocarcinoma of the prostate, and all survived for at least 12 months.
Medicare payments were calculated for a 7-month treatment
interval: 1 month before diagnosis to 6 months after. Patients who were
enrolled at a health maintenance organization (HMO) during this period were
"This was a study of direct medical costs only. We made no
attempt to measure indirect costs, such as the cost of patient time for
appointments and treatment, and recovery time from procedures," Dr.
Burkhardt commented. "We made no attempt to state any conclusions about
the effectiveness of the different treatments."
Dr. Burkhardt noted that the study was started while he was on
the research staff of the American College of Radiology (ACR), Reston,
"It is important to note the time period of this studyhow
old the data are," he told ONI in a postconference interview. Costs and
medical practices have changed since the study was performed, he said, but
current numbers are not available.
Cost is just one factor, along with medical effectiveness and
quality of life, that needs to be considered in evaluating prostate cancer
treatments, Dr. Burkhardt noted.
He concluded: "If cost is the main issue, then radiation
therapy is more attractive, but generally, in medical treatment, that is not
the primary issue."