Online Program

Longitudinal comparison of patient-level outcomes and costs across prostate cancer treatments with urinary problems

Wednesday, November 6, 2013

Leslie Wilson, PhD, Departments of Medicine and Pharmacy, University of California San Francisco, San Francisco, CA
Jun Tang, PhD, Department of Clinical Pharmacy, University of California San Francisco
Martin Sanda, MD, Department of Urology, Harvard Medical School, Beth Israel Deaconess Medical Center
Carly Paoli, PharmD, MPH, Global Health Economics, Amgen, Inc
Alan Paciorek, BS, Department of Urology, University of California San Francisco
Matthew Cooperberg, MD, MPH, Department of Urology, University of California San Francisco
Peter Carroll, MD, MPH, Department of Urology, University of California San Francisco
Objectives:Prevalence of urinary problems(UP) after prostate cancer treatment is as high as 40% with significant quality of life impact. We compared direct costs of UP treatment across treatment groups and determined predictors of long-term UP costs. Methods:Longitudinal, observational cohort study analyzed demography, treatment, and quality-of-life data from Cancer of Prostate Strategic Urologic Research Endeavor (CaPSURE) registry. UP medication and surgical treatment costs were compared among treatment groups: radical prostatectomy(RP), electron beam radiation therapy(EBRT), brachytherapy(BT), and watchful waiting(WW), for a maximum 14 years and using 2009 costs. Means and proportions were compared using Chi-square and F-statistics to determine significant differences among treatment groups. Bootstrapped regression models compared the relative effects of primary treatment, D'Amico risk groups, age, change in urinary function (UF) and urinary bother (UB) on 3-monthly UP treatment costs. Results: The 3,276 patients were 64.3 years at diagnosis. Distribution of treatment groups was RP(61.6%), BT(17.34%), EBRT(12.45%), BT+EBRT(5.40%), WW(2.08%), and RP+EBRT(1.13%). Mean UP treatment costs across all patients were $144/year. Those greater than 74 years old had highest UP treatment costs($289/year). Multivariate results showed patients in the RP group incurred significantly(18.1%, p<.0001) lower UP treatment costs post-prostate treatment compared to WW, with other treatments not significant. UF change from baseline was not significant but UB changes were associated with 85.6%(p=0.052) higher UP treatment costs. Conclusions:Cost of UP treatment, along with UB score change from baseline, can be an indicator of both the extent of dysfunction and the desire for success and adherence to UP treatments after prostate cancer treatment.

Learning Areas:

Biostatistics, economics
Conduct evaluation related to programs, research, and other areas of practice

Learning Objectives:
Compare direct costs of urinary incontinence treatment in prostate cancer patients. Determine the predictors of long term urinary incontinence costs.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal or co-principal investigator of multiple state, local and/or federally funded grants focusing on economics. Among my scientific interests has been comparisons of the costs of prostate cancer treatments.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.