Costs of medical care after open or minimally invasive prostate cancer surgery: A population-based analysis.

Abstract

6016 Background: The rapid uptake of minimally-invasive radical prostatectomy (MRP) has occurred despite little evidence of better short-term functional and oncologic outcomes compared with open radical prostatectomy (ORP). MRP is generally more expensive than ORP, but it is not clear whether subsequent health care costs vary. Methods: In the SEER-Medicare dataset we identified men age 66 or older who had MRP or ORP in 2003-2006 for early-stage prostate cancer. MRP included laparoscopic and robot-assisted procedures. Total cost was estimated as the sum of Medicare payments in all claims for inpatient and outpatient care, physician services, home health and hospice care and durable medical equipment in the first year from the date of admission for surgery. Payments were adjusted for inflation and geographic variability and reported in 2006 $US. The impact of surgical approach on cost was estimated in a multivariable linear regression of log-transformed total payments. Results: Of 5,795 men who had prostate cancer surgery, 4,693 (81%) had ORP and 1,102 (19%) had MRP. The groups were similar in age, preoperative PSA, Gleason score, clinical tumor stage and comorbidity. Mean total first-year costs were $1,200 greater for men who had MRP ($16,900 vs. $15,700, p=0.08). In both groups, costs associated with the initial surgical procedure and hospitalization accounted for 65% of total first-year costs. Controlling for patient and tumor characteristics, total costs were 2% greater with MRP compared with ORP, but this difference was not statistically significant. Costs were greater for men who were older, black, lived in the Northeast, had lymph node involvement, more advanced tumor stage or greater comorbidity. Mean first-year costs decreased over time, by almost 2% per year (p<0.05). Conclusions: Mounting evidence suggests that MRP and ORP are similar with respect to complications, functional impairment and oncologic outcomes. Our analysis of prostate cancer patients in Medicare suggests that the procedures are also associated with similar costs. From a payer’s perspective, any benefits associated with MRP − including robotic procedures − do not yield net savings compared with ORP in the first year after surgery.