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Urology. 2010 Sep;76(3):703-7. doi: 10.1016/j.urology.2009.12.071. Epub 2010 Apr 9.

Cost comparison between watchful waiting with active surveillance and active treatment of clinically localized prostate cancer.

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  • 1Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. corcoranat@upmc.edu

Abstract

OBJECTIVES:

In part because of concern regarding overtreatment in men with prostate cancer, watchful waiting with active surveillance (WWAS) has been increasingly used in men diagnosed with low-risk prostate cancer. The present study investigates the difference in costs between men with low-risk prostate cancer treated with up-front radical prostatectomy (RP) versus WWAS.

METHODS:

A cost model was constructed using data from centers that have published their results in men who were followed up with WWAS compared with the actual costs of up-front RP calculated from a high volume center. Two WWAS arms of 15-year duration were created in which the follow-up protocol and conversion rate to active treatment were varied.

RESULTS:

The cost of up-front RP including costs of surgery, complications, and follow up for 15 years was $15 235 per person. Costs of WWAS were estimated using annual conversion rates from WWAS to RP of both 5% and 7%. Costs per person in the WWAS arms ranged from $6558 to $11 992 in the scenarios created which represent a 43%-78.7% reduction in costs when compared with men undergoing up-front RP.

CONCLUSIONS:

Watchful waiting with active surveillance is being increasingly used in hopes of decreasing the potential overtreatment of prostate cancer in men with low-risk disease. The present study suggests that WWAS is likely to markedly decrease costs when compared with active treatment with RP.

Copyright © 2010 Elsevier Inc. All rights reserved.

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