Cost comparison of radical prostatectomy and transperineal brachytherapy for localized prostate cancer

Objectives. To compare perioperative costs associated with radical retropub ic prostatectomy (RRP) to transperineal brachytherapy (BXRT) with iodine-12 5 (I-125) seeds in the treatment of localized prostate cancer. Methods. Actual costs per case for the perioperative period were compiled p rospectively for 583 consecutive patients undergoing RRP or BXRT between Ja nuary I, 1997 and October 30, 1998 using a hospital-wide cost accounting sy stem. The total cost per case included both technical and professional comp onents. The technical costs included those incurred for anesthesiology, lab oratory medicine, medicine, pharmacy, nursing, radiology, I-125 seeds, and BXRT technicians. Professional costs included fees from anesthesiology, lab oratory, medicine, urology, radiation oncology, and physics. Cases were div ided into three groups for analysis: group 1, RRP (n = 404); group 2, BXRT with planning ultrasound performed in the office setting before implantatio n (n = 107); and group 3, BXRT with planning ultrasound performed in the op erating room at the time of implantation (n = 72). Results are reported as relative cost ratios, with RRP assigned a relative cost of 1.0. Results. The total relative perioperative cost for BXRT exceeded that for R RP by 85% to 105%. Technical cost, exclusive of I-125 seeds, was substantia lly lower for BXRT (relative cost 0.36 to 0,42) but was more than offset by the cost of the seeds when comparing total cost with RRP. Performance of t he planning ultrasound in the operating room (group 3) increased the total cost by 20%. The categorical technical costs for both BXRT groups were sign ificantly lower for anesthesiology, laboratory medicine, medicine, pharmacy , and nursing but were significantly higher for radiology. The total profes sional costs were similar for all groups. Conclusions. Perioperative costs of BXRT with I-125 seeds are substantially higher than RRP In the treatment of localized prostate cancer, primarily b ecause of the cost of the seeds. (C) 2000, Elsevier Science Inc.