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Active surveillance for localized prostate cancer reduces Medicare costs

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October 8, 2018

Justin G. Trogdon

Increasing the use of active surveillance among older men with prostate cancer and a Gleason score of 6 or lower could reduce 3-year costs to the Medicare program by $320 million, according to results of a retrospective study published in JAMA Oncology.

The total estimated 3-year costs to the Medicare program associated with diagnosing men aged older than 70 years with prostate cancer reached approximately $1.2 billion, results showed.

“National guidelines already do not recommend screening for prostate cancer among men aged 70 years or older, which is largely due to the fact that prostate cancer at an older age is often slow growing and, therefore, is unlikely to be the cause of their mortality,” Justin G. Trogdon, PhD, associate professor in the department of health policy and management at the Gillings School of Global Public Health of University of North Carolina at Chapel Hill, told HemOnc Today. “In this paper, we also highlight the burden to patients of diagnosis and treatment they do not need in terms of the costs of unnecessary side effects, like urinary incontinence and sexual dysfunction. Screening for, diagnosing and treating prostate cancer in older men is often a net burden to patients.”

U.S. Preventive Services Task Force guidelines state that the harms from screening and treatment for localized prostate cancer are greater among men aged older than 70 years. Therefore, an opportunity exists to reduce delivery of low-value health care services by reducing early prostate cancer diagnosis and overtreatment in this population.

Trogdon and colleagues pooled data from the NCI’s SEER-Medicare linked claims database to assess costs associated with the diagnosis, treatment, follow-up and management of adverse events among 49,692 men aged 70 years and older (52.3% aged 76 years or older) diagnosed with primary, nonmetastatic prostate cancer between 2004 and 2007.

Researchers found the total 3-year cost associated with prostate cancer diagnoses was $1.2 billion among men diagnosed in 2004, 2005, 2006 and 2007.

Median per-patient cost within 3 years after a diagnosis was $14,453 (interquartile range [IQR], 4,887-27,899), of which 73% (median, $10,558; IQR, 1,990-23,718) was associated with treatment.

Among men with a Gleason score of 6 or lower (n = 20,982), the 3-year median total cost was $1,914 for those who chose active surveillance vs. $12,616 for those who did not. Had all the men in this group opted for active surveillance, Medicare costs would have been reduced by $320 million.

The researchers noted several study limitations, including the absence of men with managed care plans who may have a lower incidence of diagnosis and treatment. It is not known if cancer cases included in the analysis were detected through screening or after symptom development, and longer follow-up could translate to more treatment and morbidity management, which would further increase costs.

“As we try to increase the value of medical care in the U.S., it is important to not only focus on the value of new treatments and services,” Trogdon said. “We need to continue to identify low-value care that is overused and find ways to incentive physicians to cut back on those services.” – by Jennifer Southall

For more information:

Justin Trogdon, PhD, can be reached at University of North Carolina at Chapel Hill, 250 E. Franklin St., Chapel Hill, NC 27514; email: justintrogdon@unc.edu.

Disclosures: The authors report no relevant financial disclosures.

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