Annual detection of prostate cancer in men 70 and older costs Medicare an estimated $1.2 billion every three years, and most costs are treatment-related, according to new findings
Using active surveillance in all older patients with a Gleason score of 6 or below could cut these costs by $320 million, Dr. Ronald C. Chen of the University of North Carolina at Chapel Hill and colleagues report in JAMA Oncology, online September 13.
The U.S. Preventive Services Task Force, American College of Physicians and American Urological Association recommend that men 70 and older not receive prostate-cancer screening, Dr. Chen and his team note.
"The lack of potential benefit in diagnosing prostate cancer in elderly men also relates to the unclear benefit from aggressive treatment when a patient is diagnosed," they add. "On the other hand, treatment is associated with sexual dysfunction, bowel problems, urinary adverse effects, and decreased health-related quality of life."
The authors looked at data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program on more than 49,000 men diagnosed with prostate cancer, 42% of whom had a Gleason score of 6 or lower. Thirty-four percent had a score of 7 and 18% had a score of 8-10.
The median per-patient cost overall, including diagnosis and workup, treatment, morbidity, and follow-up, was $14,453 within three years of diagnosis, with treatment costs accounting for $10,558.
The median cost per patient was $12,616 for men with Gleason scores of 6 or lower, while median total cost was $1,914 for those managed more conservatively, with no treatment within a year after diagnosis.
The authors estimate the Medicare cost of prostate-cancer detection in men over 75 at $601 million, with a savings of $132 million if they all received conservative treatment.
The cost of treating patients with lower Gleason scores is $451 million, the authors state while managing these patients conservatively could save $320 million.
"Elderly patients, especially those with comorbidities, are unlikely to die of prostate cancer or benefit from screening," Dr. Chen and colleagues write. "Diagnosing prostate cancer in this patient population may result in a net harm to patients, and further represent a misallocation of limited health care resources."