Prostate cancer patients age 70 or older are unlikely to die of the disease, but Medicare is spending nearly $400 million annually on detection and treatment in these men, a study shows.
Approximately $150 million is attributed to men with low-grade prostate cancer, which could be treated with active surveillance instead of more aggressive methods. Researchers estimate that $320 million could be spared over the course of three years if these men received conservative treatment.
The study, “Total Medicare Costs Associated With Diagnosis and Treatment of Prostate Cancer in Elderly Men,” was published in the journal JAMA Oncology.
In older patients, aggressive treatment is seldom advantageous and leads to similar survival rates as a conservative approach — one where patients are actively monitored but do not receive any treatment unless their disease shows signs of progression. Reducing early prostate cancer diagnosis and overtreatment in elderly men could therefore save the U.S. healthcare system millions without causing any harm to patients.
Researchers at the University of North Carolina at Chapel Hill reviewed information collected from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to determine the Medicare costs incurred by elderly prostate cancer patients and assess the financial burden imposed by the disease.
SEER is a United States epidemiological surveillance program by The National Cancer Institute that covers 28% of the country. It collects demographic information and disease-related characteristics of all individuals with cancer diagnosis.
The SEER-Medicare linked database electronically links individuals in SEER with their Medicare enrollment and claims data.
A total of 49,692 men with non-metastatic prostate cancer were identified, and the team analyzed their medical expenses associated with diagnosis, treatment, therapy, follow-up, and morbidity management. All participants were at least 70 years old.
Among the participants, 20,982 (42%) had low-grade or less aggressive cancer, as indicated by a Gleason score of 6 or less. There were 16,927 (34%) with a Gleason score of 7, while 9,018 (18%) reported high-grade cancer, indicated by a Gleason score of 8 to 10. There were 2,765 patients whose score was unknown.
Researchers found that the median total health care cost per patient was $14,453 within three years post-diagnosis. A significant expense was related to treatment, with a median of $10,558.
For patients with a Gleason score of 6 or less who opted for no treatment within the first year of diagnosis, the three-year median total cost per patient was $1,914, the team reported.
Overall, the three-year median cost for the annual detection of prostate cancer in men over 70 in the Medicare program was approximately $1.2 billion. But researchers claim that this could be lowered by $320 million if patients with a Gleason score of 6 or lower are actively monitored.
“Reducing detection of localized prostate cancer in elderly patients represents a potential source of significant cost savings for the U.S. Medicare program,” the study noted.
“Continued efforts to minimize overdiagnosis and overtreatment of prostate cancer will have a significant impact on reducing waste of limited health care resources,” they concluded.