Login to Access Video or Poster Abstract: MP05-13
Sources of Funding: Ajmera Family Chair in Urologic Oncology

Introduction

Treatment options for localized prostate cancer include radical prostatectomy (RP) and radiation therapy (RT). Treatment choice depends on patient age, comorbidity and preferences as well as tumor characteristics. . Initial treatment decisions can have long-term consequences that can result in complications, possible future secondary treatments and significant economic impact. We sought to compare 5-year annual treatment-related complication (TRC) costs for patients treated with RP or RT for localized prostate cancer._x000D_

Methods

We performed a population-based retrospective cohort study of all men ?18 years old who underwent RP or RT (external beam or brachytherapy) for clinically localized prostate cancer in Ontario, Canada from 2002 to 2009. Costs were determined using a validated costing algorithm using linked administrative databases, to capture inpatient hospital admissions, emergency department visits, cancer clinic visits, physician billings and Ontario Drug Benefit Plan medication usage for 5 years after treatment (including costs for initial treatment). Costs for medical care unrelated to management of prostate cancer or its treatment-related complications were excluded. Costs were adjusted for inflation to 2015 Canadian dollars. We matched men treated with RP and RT 1:1 using a propensity-score including age, income quintile, co-morbidity score and year of diagnosis. Negative binomial regression was used to assess the association between treatment modality and costs.

Results

In total, 28,849 men underwent treatment for localized prostate cancer from 2002 – 2009 in Ontario. Men who underwent RT (n=12,675) were older, from less affluent neighborhoods and had more comorbidities than men who underwent RP (n=16,174, p<0.001). Men who underwent RT had higher total 5-year per patient treatment-related costs than men who underwent RP ($16,716/pt vs. $13,213/pt), with a mean incremental difference of $3,503/pt._x000D_ Men who underwent RT had a lower relative cost in their first year after treatment, compared to those receiving RP (RR 0.97, 95% CI 0.94 – 1.0, p=0.025). There was no difference in relative cost in year two (p=0.1). In years 3, 4 and 5, RT had a significantly higher relative cost than RP (p<0.05 for all). _x000D_

Conclusions

Men who undergo RT have significantly higher 5-year total treatment-related costs compared to men who undergo RP. Relative costs are higher in the first year for patients treated with RP and increasingly higher in subsequent years for patients treated with RT.

Funding

Ajmera Family Chair in Urologic Oncology