A comprehensive analysis of cost of an active surveillance cohort compared to radical prostatectomy as primary treatment for prostate cancer

Active surveillance (AS) seems to be a cost-effective strategy. However, most publications are based on simulation models of theoretical cohorts, and long-term implications are not usually considered.

To assess the real cost differences of two cohorts of men with low-risk prostate cancer (PCa) treated with AS or laparoscopic radical prostatectomy (LRP) in a public health system.

Patients diagnosed from 2005 to 2009 were included in an AS program (Group 1) or treated with LRP at diagnosis (Group 2), with a minimum follow-up of 5 years. Actual costs for each patient were calculated on an individual basis: Group 1: semiannual PSA measurements and repeat biopsies are scheduled every 1-3 years. Costs of outpatient clinic visits were calculated, as well as all tests required for monitoring or active treatment. Group 2: costs of the procedure, emergency visits, re-admissions and outpatient clinic visits were calculated, as well as costs of oncological salvage therapies or functional surgical procedures.

Out of 151 men diagnosed with low-risk PC, 54 (35.8%) were included in an AS (Group 1) and 97 (64.2%) were submitted to LRP (Group 2). Mean follow-up for both groups was 6.5 years (SD 1.8) and 6.7 years (SD 1.4), respectively, p = 0.49. Group 1 had a total cost per patient of 2970.47€. Group 2 had a total cost per patient of 5694.06€.

AS was associated with cost-saving over LRP. This cost reduction of AS in the management of low-risk PCa is based on the accounting of real costs of individual patients and confirms previously published estimation-based reports.

World journal of urology. 2018 Oct 01 [Epub ahead of print]

Carmen Pozo, Virginia Hernández, Carlos Capitán, Enrique de la Peña, Guillermo Fernández-Conejo, María Del Mar Martínez, Silvia Del Riego, Elia Pérez-Fernández, Carlos Llorente

Urology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain. ., Urology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain., Department of Cost Analysis, Hospital Universitario Fundación Alcorcón, Madrid, Spain., Research Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain.

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