Relationship of first-year costs of treating localized prostate cancer to initial choice of therapy and stage at diagnosis: Results from the CaPSURE database

Objectives, To determine the relationship among the initial choice of thera py, stage at presentation, and first-year treatment costs in men with newly diagnosed localized prostate cancer. Methods. First-year resource use and clinical data were collected for 235 s ubjects with newly diagnosed localized prostate cancer. The costs were esti mated from the standard Medicare payment schedules. The relationship among the initial therapy, stage at presentation, and overall cost was examined f or the entire cohort and in the subgroup of patients who underwent radical prostatectomy. In addition, the inpatient, outpatient, and medication cost components were evaluated separately to determine what influenced the chang es in cost by stage. Results. The mean first-year cost of treating localized prostate cancer in CaPSURE was $6375. When broken down by stage, the mean first-year cost for patients with Stage Tie was $5731, with T2a/b was $6426, and with Stage T2c was $6810 (P = 0.059). The initial treatment choice was significantly asso ciated with the total first-year costs (P < 0.001). The mean cost specifica lly for radical prostatectomy patients with Stage Tie disease was $6881, wi th T2a/b was $7216, and with T2c was $8027 (P = 0.004). The increases in th e first-year cost with higher stage appeared to primarily be associated wit h increased in patient resource use and the greater use of adjuvant hormona l therapy. Conclusions. The first-year costs of treating localized prostate cancer in CaPSURE are associated with the choice of primary and adjuvant therapy. Thi s supports the notion that cost savings may be possible with earlier detect ion of disease or by minimizing the use of hormonal adjuvant therapy. UROLO GY 57: 499-503, 2001. (C) 2001, Elsevier Science Inc.