ADJUVANT RADIATION VERSUS OBSERVATION - A COST-ANALYSIS OF ALTERNATE MANAGEMENT SCHEMES IN EARLY-STAGE TESTICULAR SEMINOMA

Purpose: This study wets designed to compare costs radiation versus ob servation in the management of early-stage testicular seminoma after i nguinal orchiectomy. Materials and Methods: A line-by-line inspection of the charges generated during a course of adjuvant pelvic and paraao rtic radiotherapy and of three cycles of bleomycin, etoposide, and pla tinum salvage chemotherapy was performed for five patients who receive d irradiation and five patients who received salvage chemotherapy. The average charge for either treatment was then calculated. Only those c harges directly associated with the diagnosis of seminoma were include d in the analysis. Follow-vp charges were also generated from the pati ents' billing records. The optimum follow-up regimen for either manage ment option was derived from a synthesis of the international literatu re. A 5% rate of failure was assumed if adjuvant irradiation was admin istered, and a 15% rate of failure was assumed if observation was the option chosen. Charges were truncated at 5 years. Results: The total c harge generated over 5 years based on following a policy of observatio n is $27,223 per patient versus $19,557 if the option of adjuvant irra diation in chosen. Using University of Wisconsin institutional reimbur sement rates, the estimated costs were $20,487 and $14,722 for the opt ion of observation and adjuvant radiation, respectively. The cost equi valence point between the two options occurs at 2.5 years, when the in itial cost of adjuvant radiotherapy is matched by the cost generated d uring the period of observation. The maximum cost difference is achiev ed by 5 years. Conclusion: Following a policy of observation postorchi ectomy for early-stage testicular seminoma generates 39% more medical costs per patient over a 5-year followup period than does following th e standard policy of adjuvant irradiation to the pelvic and paraaortic regions, with no reported difference in outcome. (C) 1996 by American Society of Clinical Oncology.