The economic burden of prostate cancer survivorship care

Most men live with rather than die of prostate cancer. As a result, survivors have a protracted course, harboring considerable clinical and economic implications. Thus, we investigated the extent to which health service use and expenditures vary during continuing prostate cancer care.

We identified 105,961 patients diagnosed with prostate cancer between 1992 and 2005 using Surveillance, Epidemiology and End Results-Medicare data. All Medicare payments for prostate cancer related care were assigned to a phase of care (initial, continuing care or end of life), price adjusted and standardized. Patients were sorted into 5 equal groups (quintiles) based on annual per capita continuing care expenditures. We then enumerated the use of common prostate cancer health services.

Average annual per capita continuing care phase expenditures were $36 to $4,724 in the lowest to the highest expenditure group, respectively. Office visits (27.3%) and androgen deprivation (62.7%) comprised most physician related payments for prostate cancer survivorship care. The use of each common health service grew with increasing continuing care intensity (each p <0.001). However, the magnitude of variation in each prostate cancer risk stratum was substantially greater than that between risk strata, eg low risk and metastatic disease, in patients with similar spending.

In Medicare beneficiaries the prostate cancer continuing care phase is associated with substantial variation, resulting in potentially unnecessary excess cost to the health care system. Variation was evident across the spectrum of disease severity and implies the need for better evidence to inform clinical practice.