Active surveillance of men with low-risk prostate cancer may be better for quality of life and is cost-effective compared with immediate treatment, reports a study published today in CMAJ Open.
Prostate cancer is the most common cancer in Canadian men and the third leading cause of death from cancer. The incidence of prostate cancer, and its associated economic costs, has increased 50% over the last three decades, although most cases are low to intermediate risk. Many cancers, despite being at low risk of progressing, are treated, and overtreatment can affect patient quality of life.
“Despite published guideline recommendations, over treatment of prostate cancer is common in the United States and elsewhere, with about 70% to 90% of patients undergoing immediate treatment,” writes lead author Dr. Alice Dragomir from the Research Institute of the McGill University Health Centre (RI-MUHC) and assistant professor in the Department of Surgery, Division of Urology at McGill University, Montréal, Quebec. “In Canada, about 75% of patients with prostate cancer have received immediate treatment from 1995 through 2002. It is believed today that more than half of these patients did not require immediate treatment at the time of diagnosis, but the treatment led to cost and morbidity.”
Researchers developed a model to estimate cancer costs for active surveillance — watching and waiting to see if cancer progresses — and immediate treatment of patients in Quebec, Canada.
Results and Discussion:
They found that active surveillance with follow-up over 5 years could save about $96 million at the national level because the high cost of treating cancer that was at low risk of progressing could be avoided. With active surveillance, the cost per patient for the first year and the subsequent 5 years of follow-up was estimated at $6200 compared with $13 735 for immediate treatment.
“Our study demonstrates that for eligible patients, active surveillance could offer not only the known clinical advantages from the patient’s perspective, but also economic benefits from the health care system perspective,” adds senior author Dr. Armen Aprikian, MUHC chief of oncology and head of the Division of Urology at McGill University.
“The results of our study add to the economic rationale advocating active surveillance for eligible men with low-risk prostate cancer and highlights estimated cost savings specific to the Canadian health system,” the authors conclude.
CMAJ Open, an online open-access journal that publishes high-quality medical and health research, comes from the same family as the Canadian Medical Association Journal (CMAJ).
Alice Dragomir, Fabio L. Cury, Armen G. Aprikian. Active surveillance for low-risk prostate cancer compared with immediate treatment: a Canadian cost comparison. cmajo April 24, 2014 vol. 2 no. 2 E60 E68. doi:10.9778/cmajo.20130037
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