XWH - 08 - 1 - 0283 TITLE : Patterns of Care , Utilization , and Outcomes of Treatments For Localized Prostate Cancer

PurposeIntensity-modulated radiation therapy (IMRT) and laparoscopic or robotic minimally invasive radicalprostatectomy (MIRP) are costlier alternatives to three-dimensional conformal radiation therapy(3D-CRT) and open radical prostatectomy for treating prostate cancer. We assessed temporaltrends in their utilization and their impact on national health care spending.MethodsUsing Surveillance, Epidemiology, and End Results–Medicare linked data, we determined treat-ment patterns for 45,636 men age 65 years who received definitive surgery or radiation forlocalized prostate cancer diagnosed from 2002 to 2005. Costs attributable to prostate cancer carewere the difference in Medicare payments in the year after versus the year before diagnosis.ResultsPatients received surgery (26%), external RT (38%), or brachytherapy with or without RT (36%).Among surgical patients, MIRP utilization increased substantially (1.5% among 2002 diagnoses v28.7% among 2005 diagnoses, P .001). For RT, IMRT utilization increased substantially (28.7% v81.7%; P .001) and for men receiving brachytherapy, supplemental IMRT increased significantly(8.5% v 31.1%; P .001). The mean incremental cost of IMRT versus 3D-CRT was $10,986 (in2008 dollars); of brachytherapy plus IMRT versus brachytherapy plus 3D-CRT was $10,789; ofMIRP versus open RP was $293. Extrapolating these figures to the total US population results inexcess spending of $282 million for IMRT, $59 million for brachytherapy plus IMRT, and $4 millionfor MIRP, compared to less costly alternatives for men diagnosed in 2005.ConclusionCostlier prostate cancer therapies were rapidly and widely adopted, resulting in additional nationalspending of more than $350 million among men diagnosed in 2005 and suggesting the need forcomparative effectiveness research to weigh their costs against their benefits. J Clin Oncol 29:1517-1524. © 2011 by American Society of Clinical Oncology