An economic overview of prostate carcinoma

BACKGROUND. In the United States in 2000, 180,400 new cases of prostate car cinoma were expected to occur, with 31,900 men expected to die from this il lness. In addition, prostate carcinoma is the cause of over half a million disability-adjusted life-years. This study summarizes the current body of p ublished literature about the economics of prostate carcinoma. METHODS. The authors used a MEDLINE-based literature review for relevant ar ticles from 1990 to the present. RESULTS. The authors' search returned 216 articles, 56 of which met the cri teria of interest. Prostate carcinoma is costly to treat, currently averagi ng above $20,000 per case. Cost of care is directly related to stage of dis ease and comorbidity. Substantial geographic variation exists, even within small locales, with regard to care patterns and cost. In-hospital mortality , length of stay, and cost are inversely related to case volume. Care rende red in health maintenance organizations is generally less technologically i ntensive than in the fee-for-service sector. Out of the 18 cost studies exa mined, 13 were, cost-minimization analyses and five assessed cost-effective ness. From a cost perspective, laparoscopic pelvic node dissection was favo red over an open pelvic procedure; 3D conformal radiation therapy was favor ed over 2D; and radiation therapy was favored over radical prostatectomy. C ost-effectiveness analyses favored the use of metastron, mitroxantone plus prednisone over prednisone alone, flutamine with either medical or surgical castration, and orchiectomy as the androgen suppression therapy. CONCLUSIONS. The literature on the economics of prostate carcinoma is relat ively meager. Most cost studies were done on small samples, had short follo w-up periods, used charges rather than cost data, and did not include adequ ate representation of all stages of disease. Additional research is needed. Cancer 2001;92: 2796-810. (C) 2001 American Cancer Society.