TWO-YEAR COST ANALYSIS OF RADICAL PROSTATECTOMY - INDEX PROCEDURES AND ADJUVANT THERAPIES
Author(s)
Rick Ditto, MS1, Sheetal Aggarwal, -2, Scott M. Myers, MBA2, Hannah C. Kwiatkowski, MPH, PhD1, Robert M. Mordkin, MD, FACS3;
1Axogen, Tampa, FL, USA, 2PearlDiver, Colorado Springs, CO, USA, 3VHC Health, Arlington, VA, USA
1Axogen, Tampa, FL, USA, 2PearlDiver, Colorado Springs, CO, USA, 3VHC Health, Arlington, VA, USA
OBJECTIVES: To quantify two-year direct medical costs for prostate cancer patients undergoing radical prostatectomy, with emphasis on the contribution of adjuvant therapies to overall expenditures.
METHODS: A retrospective analysis was conducted using the PearlDiver Mariner claims database (2015-2023). Patients with malignant prostate neoplasm who underwent radical prostatectomy and maintained ≥6 months pre-index and ≥24 months post-index continuous enrollment were included. Facility and physician services were calculated using CMS and PayerPrice fee schedules. Total costs over two years were categorized as index surgery, radiotherapy, chemotherapy, immunotherapy, hormone therapy, imaging, diagnostics, and rehabilitation. Utilization rates and mean costs per treated patient were calculated for each category.
RESULTS: Among 102,195 patients meeting inclusion criteria, the mean two-year cost was $50,700 per patient. The index surgical procedure accounted for $17,698 (34.9% of total cost). Adjuvant therapies collectively represented the majority of expenditures. Radiotherapy was the most significant driver: 12.3% of patients received radiation, with mean costs of $221,861 per treated patient, representing 53.7% of two-year treatment costs. Chemotherapy was administered to 23.7% of patients, with a mean cost of $50,189 per treated patient, contributing 23.5% of two-year treatment costs. Hormone therapy was used in 9.3% of patients, averaging $7,859 per treated patient (1.4% of total costs). Immunotherapy was rare (0.6% of patients) but costly when used ($86,468 per treated patient), though its overall impact was minimal. Diagnostics (53.5% of patients, 2.1% of costs) and imaging (48.2% of patients, 3.4% of costs) also contributed to two-year costs.
CONCLUSIONS: Adjuvant therapies, particularly radiotherapy and chemotherapy, accounted for a disproportionate share of two-year treatment costs following radical prostatectomy. These findings highlight the need to consider the entire treatment pathway when evaluating economic value in prostate cancer care. Understanding facility economics and downstream resource utilization is essential for informed, value-based clinical decision-making.
METHODS: A retrospective analysis was conducted using the PearlDiver Mariner claims database (2015-2023). Patients with malignant prostate neoplasm who underwent radical prostatectomy and maintained ≥6 months pre-index and ≥24 months post-index continuous enrollment were included. Facility and physician services were calculated using CMS and PayerPrice fee schedules. Total costs over two years were categorized as index surgery, radiotherapy, chemotherapy, immunotherapy, hormone therapy, imaging, diagnostics, and rehabilitation. Utilization rates and mean costs per treated patient were calculated for each category.
RESULTS: Among 102,195 patients meeting inclusion criteria, the mean two-year cost was $50,700 per patient. The index surgical procedure accounted for $17,698 (34.9% of total cost). Adjuvant therapies collectively represented the majority of expenditures. Radiotherapy was the most significant driver: 12.3% of patients received radiation, with mean costs of $221,861 per treated patient, representing 53.7% of two-year treatment costs. Chemotherapy was administered to 23.7% of patients, with a mean cost of $50,189 per treated patient, contributing 23.5% of two-year treatment costs. Hormone therapy was used in 9.3% of patients, averaging $7,859 per treated patient (1.4% of total costs). Immunotherapy was rare (0.6% of patients) but costly when used ($86,468 per treated patient), though its overall impact was minimal. Diagnostics (53.5% of patients, 2.1% of costs) and imaging (48.2% of patients, 3.4% of costs) also contributed to two-year costs.
CONCLUSIONS: Adjuvant therapies, particularly radiotherapy and chemotherapy, accounted for a disproportionate share of two-year treatment costs following radical prostatectomy. These findings highlight the need to consider the entire treatment pathway when evaluating economic value in prostate cancer care. Understanding facility economics and downstream resource utilization is essential for informed, value-based clinical decision-making.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE479
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Oncology, STA: Surgery