Vol. 185, No. 4S, Supplement, Sunday, May 15, 2011
PSA (⬍2.5 ng/mL) were $19,313 over the 24-month period. Compared with these men, charges were $4,087 higher for men with PSA 2.5–3.9 ng/mL, and $4,725 higher for men with PSA ⱖ4.0 ng/mL. Charges were $1,519 lower for men with no PSA tests. Prostate cancer was diagnosed in 0.7% of men with PSA ⬍2.5 ng/mL, 4.1% of men with PSA 2.5–3.9 ng/mL, and 22.3% of men with PSA ⱖ4.0 ng/mL. CONCLUSIONS: The cost of PSA testing is not limited to the cost of the lab test and biopsy. Even a mildly elevated PSA (2.5–3.9 ng/mL) is associated with a cascade of events with considerable cost implications for the majority of men who will not have a diagnosis of cancer. Source of Funding: None
312 A SIMULATION STUDY OF THE COSTS OF ACTIVE SURVEILLANCE COMPARED TO IMMEDIATE TREATMENT FOR PROSTATE CANCER Kirk Keegan*, Nashville, TN; Marc Dall’Era, Blyth Durbin, Christopher Evans, Sacramento, CA INTRODUCTION AND OBJECTIVES: With over 230,000 cases diagnosed each year and the often prolonged natural history, considerable costs are accrued at all stages of prostate cancer management. Several options exist for treating localized disease and active surveillance (AS) has emerged as a viable option for men at low risk for disease progression. We sought to better understand the costs of an active surveillance paradigm and compare them to the most common contemporary modes of immediate therapy. METHODS: Utilizing a theoretical model cohort of 100 men selecting active surveillance for prostate cancer, the numbers of men remaining on AS and numbers exiting to each of 5 treatments over the course of 5 years were simulated from a Markov model. From the literature we estimated the probability of exiting AS each year and the probability of selecting a specific treatment given that a patient exited AS. We focused on direct health care costs of prostate cancer treatment. Total weighted relative value units (RVUs) were used to calculate the standard cost per RVU multiplied by the RVU value to arrive at the standard cost per treatment reported in 2009 dollars. Discounting was performed to account for the effect of passage of time on the value of costs and income and was estimated at 5% per year. A sensitivity analysis was performed to assess the outcomes of varying pre-determined variables in the model. RESULTS: The average simulated cost of 5 years of treatment for 100 men starting out in active surveillance was $2,702,191, with a 95% confidence interval of ($2,701,962, $2,702,419), and the average simulated cost of 5 years of treatment for 100 men starting with treatment up front was $3,715,633, with a 95% confidence intervals of ($3,715,378, $3,715,888). The mean cost savings for starting active surveillance was $1,013,422, with a 95% confidence interval of ($1,013,100, $1,013,785), z-test p ⬍0.0001 as the majority of men remain untreated at 5 years. Increasing the frequency of surveillance biopsies to yearly reduced the cost difference between treatment approaches, however, still resulted in a cost benefit with active surveillance over 5 years. Varying the percentage of men exiting active surveillance each year showed the greatest costs associated with 30% of men exiting at year 3. CONCLUSIONS: Prostate cancer treatments incur substantial costs over time. Despite the need for frequent PSA measurements and repeat prostate biopsy, AS with delayed selective intervention can result in a costs savings of over $1 million at 5 years. Source of Funding: None
THE JOURNAL OF UROLOGY姞
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313 POTENTIAL COST SAVINGS OF ACTIVE SURVEILLANCE OVER UP FRONT TREATMENT OF PROSTATE CANCER FOR THE US HEALTHCARE SYSTEM Anthony Corcoran*, Ronald Benoit, Pittsburgh, PA INTRODUCTION AND OBJECTIVES: Active surveillance (AS) is being increasingly utilized in men diagnosed with low risk prostate cancer. A recent analysis has demonstrated that on an individual basis AS is less costly than active treatment with radical prostatectomy (RP). The present study carries this analysis further by evaluating the potential savings to the health care system if AS is instituted on a widespread basis. METHODS: The costs per patient over a 15 year time horizon were calculated using a Medicare reimbursement model. The cost per patient if up front treatment with RP was pursued was $15,235 while the costs of AS ranged between $6,558 and $11,992, depending on the surveillance protocol utilized. The present study applies the same model to investigate the potential costs savings applied across the United States healthcare system based on current trends in the management of men eligible for AS. Costs were calculated through a range of costs depending on the entry criteria utilized for AS. RESULTS: It is estimated that 217,730 men will be diagnosed with prostate cancer in 2010. Depending on the entry criteria used to enroll men in AS protocols, 16.9% to 46.4% of these men will be eligible for this option. The costs savings to the health care system will range from $119,330,628 to $876,608,849 if all eligible men follow AS rather than up front treatment. The costs savings will vary depending on not only the entry criteria for AS but also the surveillance protocol followed and the criteria to move from AS to active treatment. CONCLUSIONS: Active surveillance can lead to a significant cost savings to the health care system if all eligible men enroll in AS rather than pursue up front active treatment as $120 to $875 million dollars of savings is possible. Assuming that the reports that demonstrate that men who pursue AS who cross over to active treatment have similar oncologic outcomes to men who pursue up front treatment, this cost savings will be achieved without any decrease in cause specific survival in men with prostate cancer. Source of Funding: None
314 NEW CARE COORDINATION SYSTEM IMPROVES THE QUALITY, EFFICIENCY AND COST OF CARE FOR PATIENTS WITH HEMATURIA Jessica T. Casey*, John Cashy, Amy Tourne-Schwab, Chicago, IL; Nilmini Wickramasinghe, Melbourne, Australia; Anthony J. Schaeffer, Christopher M. Gonzalez, Lyle L. Berkowitz, Chicago, IL INTRODUCTION AND OBJECTIVES: As microscopic and gross hematuria are common urologic referrals with a defined best practice pathway for evaluation, we sought to determine if inclusion of a care coordination system to manage the referral process would lead to improved quality, efficiency and economic outcomes. METHODS: A care coordination system was developed which included the primary care physician’s use of a standardized “Hematuria Pathway” checklist which included orders for a CT scan followed by a urology referral with cystoscopy. A care coordinator facilitated the ordering process and reviewed the progress at 4 weeks to ensure completion. This system was used for patients referred for hematuria from May 2009 to May 2010. The outcomes for these “navigated” patients (group A, n⫽106) were compared to patients referred to our urology department for hematuria during the same time period who did not use a care coordination system (group B, n⫽105). RESULTS: Demographics, presenting symptoms, and final diagnoses were equal between groups, and there was no significant difference in the percentage of patients who completed the entire hematuria work-up (55.7% A vs. 47.6% B, p⫽0.24) or were seen by urology (84.0% A vs. 77.1% B, p⫽0.21). However, patients in group A