Purpose: The savings to U.S. health expenditures from the application of CER is potentially large. We estimate the potential savings by applying CER findings to treatment of localized prostate cancer. Multiple treatment options are available for initial management; there is inadequate evidence to conclude one is superior over another.
Method: We used a U.S. commercial insurance claims database consisting of 1.2 million covered lives to identify a cohort of patients with newly diagnosed localized prostate cancer. We identified individuals treated with active surveillance (AS), radical prostatectomy (RP), brachytherapy (brachy), external beam radiation therapy (EBRT), intensity modulated radiation therapy (IMRT) and combinations of treatments administered within 12 months of initial diagnosis. We calculated total and prostate cancer related health expenditures for 24 months following diagnosis and performed multivariate analysis adjusting for age and comorbidities. We linked the cost data to estimates of treatment incidence from SEER registry and estimated the potential savings to health expenditures by migrating patients from the highest cost treatment option(s) to the lowest cost.
Result: The 24-month mean medical expenditures following a diagnosis of localized prostate cancer were $45,223 for RP, $52,264 for AS, $54,603 for EBRT, $69,760 for brachy, $95,057 for IMRT and $110,372 for multiple treatments. The 24-month mean prostate cancer related expenditures were $2,156 for AS, $10,818 for EBRT, $20,484 for RP, $25,550 for brachy and $45,194 for IRMT. Differences in costs were not accounted for by higher levels of health care utilization preceding diagnosis. When results were estimated for a population of 65 year olds with cardiac disease and diabetes, 24-month mean health expenditures estimates were $47,098 for AS, $48,708 for RP, $55,406 for EBRT, $63,848 for brachy and $101,353 for IMRT. Shifting patients from IMRT to an even split between RP and AS generated an estimated savings to U.S. health expenditures of $1.8 billion over 24 months following diagnosis. Estimated savings were $1.3 billion when adjusted for a population of 65 year old men with the most common comorbidities of cardiac disease and diabetes. Reducing the use of multiple treatments to single treatment options saves an estimated $1.3 to $1.6 billion dollars over 24 months following diagnosis.
Conclusion: Shifting patients from current treatment practices for localized prostate cancer to lower cost alternatives could generate substantial savings to U.S. health expenditures.
Candidate for the Lee B. Lusted Student Prize Competition