A comprehensive analysis of cost of an active surveillance cohort compared to radical prostatectomy as primary treatment for prostate cancer

• DOI: 10.1007/s00345-018-2500-7
• Publication Date: 2018-10-01T07:46:57Z
• Authors: Carmen Pozo; Virginia Hernández; Carlos Capitán; Enrique de la Peña; Guillermo Fernánd...; María del Mar Mar...; Silvia del Riego; Elia Pérez-Fernández; Carlos Llorente
• Keywords: Male; Prostatectomy; Salvage Therapy; Biopsy; Prostatic Neoplasms; Health Care Costs; Middle Aged; Patient Readmission; 3. Good health; Hospitalization; 03 medical and health sciences; 0302 clinical medicine; Spain; Ambulatory Care; Costs and Cost Analysis; Humans; Laparoscopy; Emergency Service, Hospital; Watchful Waiting; Aged

Active surveillance (AS) seems to be a cost-effective strategy. However, most publications are based on simulation models of theoretical cohorts, and long-term implications are not usually considered.To assess the real cost differences of two cohorts of men with low-risk prostate cancer (PCa) treated with AS or laparoscopic radical prostatectomy (LRP) in a public health system.Patients diagnosed from 2005 to 2009 were included in an AS program (Group 1) or treated with LRP at diagnosis (Group 2), with a minimum follow-up of 5 years. Actual costs for each patient were calculated on an individual basis: Group 1: semiannual PSA measurements and repeat biopsies are scheduled every 1-3 years. Costs of outpatient clinic visits were calculated, as well as all tests required for monitoring or active treatment. Group 2: costs of the procedure, emergency visits, re-admissions and outpatient clinic visits were calculated, as well as costs of oncological salvage therapies or functional surgical procedures.Out of 151 men diagnosed with low-risk PC, 54 (35.8%) were included in an AS (Group 1) and 97 (64.2%) were submitted to LRP (Group 2). Mean follow-up for both groups was 6.5 years (SD 1.8) and 6.7 years (SD 1.4), respectively, p = 0.49. Group 1 had a total cost per patient of 2970.47€. Group 2 had a total cost per patient of 5694.06€.AS was associated with cost-saving over LRP. This cost reduction of AS in the management of low-risk PCa is based on the accounting of real costs of individual patients and confirms previously published estimation-based reports.