The patients diagnosed with prostate cancer in the United States each year who are over the age of 70 cost Medicare an average of $1.2 billion over a 3-year period, according to a new study published in JAMA Oncology.
Researchers used the nationwide, population-based Surveillance, Epidemiology, and End Results (SEER) Medicare-linked database to identify nearly 50,000 men 70 years or older diagnosed with localized prostate cancer between 2004 and 2007. When they determined the Medicare costs of each patient's diagnosis, treatment, follow-up, and morbidity management, they found that the median per-patient cost over the 3 years following diagnosis was $14,453. The bulk of this expense was attributed to the treatment itself, which cost an average of $10,558 per patient.
"The tough discussions that happen in health economics are often cases where care is beneficial, but costly. That's a hard trade-off, but this one is actually easier than that," commented Justin Trogdon, PhD, first author of the study and associate professor of health policy management in the UNC Gillings School of Global Public Health. "This is a scenario where care is probably not beneficial and [is] also costly, and we are putting a dollar figure on just how costly this is."
The US Preventive Services Task Force recommends against prostate cancer screening in men over the age of 70, citing the potential harms caused by the risks of false positives, biopsy, and treatment, which can have side effects such as sexual dysfunction and urinary incontinence. Study author Ronald Chen, MD, MPH, associate professor of radiation oncology at the UNC School of Medicine, explained that because prostate cancer is commonly slow-growing, it is unlikely to be fatal for patients who are diagnosed at an older age.
"Studies indicate that we are testing for prostate cancer in people for whom the potential harms outweigh the potential benefits, and then we are treating—actually over-treating—people for a cancer that may have little to no impact on their life expectancy," he remarked. "Not following guidelines could be putting people's health at risk, and it is costing the US health care system a lot of money. It would make more sense to put these resources into other areas that could do more good for patients."
For More Information
Trogdon JG, Falchook AD, Basak R, et al (2018). Total Medicare costs associated with diagnosis and treatment of prostate cancer in elderly men. JAMA Oncol. [Epub ahead of print] DOI:10.1001/jamaoncol.2018.3701