Radiotherapy Is Less Costly Than Radical Prostatectomy

BOSTON—Radical 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 $13,952.

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 excluded.

"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, Virginia.

"It is important to note the time period of this study—how 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."