3338 - Trends in Cost Differences between Active Surveillance and Radiation Therapy for Low- and Favorable Intermediate-Risk Prostate Cancer

Purpose/Objective(s): Among different management options for low- and favorable intermediate-risk prostate cancer, active surveillance (AS) has been shown in prior studies to be least costly. However, with increasing adoption of hypofractionation, RT costs have decreased and, in parallel, AS costs have increased over time. This study examines total cost difference between AS and different modalities of RT, and whether this has changed over time.

Materials/Methods: Analysis of SEER-Medicare data that included patients age =66 diagnosed with NCCN low- or favorable intermediate-risk cancer from 2010-2016. Costs were derived from Medicare inpatient, outpatient, provider, and prescription drug files. Three-year total costs attributable to prostate cancer were calculated, and included costs related to diagnosis, treatment, surveillance and morbidity management – consistent with published methodology. A difference-in-differences (DiD) regression adjusted for demographics, NCCN risk group, and baseline comorbidity to evaluate changes in cost differences between AS and RT over time.

Results: For patients diagnosed from 2010-2013, mean total 3-year cost for AS was $5341, which increased to $6258 for patients diagnosed from 2014-16 (Table 1). In contrast, mean total 3-year cost for RT decreased from $18011 to $14073. Multivariable DiD regression showed that the difference in total costs between AS and RT decreased by $5126.02 between the two time periods. Total costs and treatment costs for all RT modalities decreased over time.

Conclusion: The cost gap between AS and RT narrowed over time due to rising surveillance costs and declining RT treatment costs. These findings highlight shifting cost considerations in prostate cancer management, emphasizing the need for ongoing cost-effectiveness assessments.