Background:To compare the costs of open retropubic radical prostatectomy (RRP), robotic-assisted radical prostatectomy (RALP), intensity-modulated radiation therapy (IMRT), low-dose brachytherapy (LDBT), stereotactic body radiotherapy (SBRT), cryotherapy (Cryo), and high-intensity focused ultrasound (HIFU) for low/intermediate-risk prostate cancer (PCa), from the healthcare system perspective.Methods:This retrospective, IRB-approved study compared the costs and charges of primary treatment options for localized PCa at Duke University Hospital between January 2018 and December 2019. We identified cases by querying the relevant disease, procedural, and charge codes from Duke Finance. Consecutive cases with NCCN high-risk disease, prior treatment, or missing institutional financial information were excluded. Costs were calculated from the point at which the treatment option was selected until the last treatment session (SBRT and IMRT) or hospital discharge (other modalities). All modalities except RRP were considered technology-intensive.Results:A total of 552 patients with a mean age of 65.0 years met the inclusion criteria. NCCN risk categories included 85 (13%) low, 218 (41%) favorable-intermediate, and 249 (46%) unfavorable-intermediate risk cases. RALP, RRP, Cryo, and HIFU were single-session treatments, whereas IMRT, SBRT, and LDBT were delivered over multiple sessions. IMRT and SBRT were the most expensive modalities, followed by RALP, HIFU, LDBT, Cryo, and RRP. The number of sessions (ρ = 0.55,p< 0.001) and being technology-intensive (ρ = 0.58,p< 0.001) were significantly correlated with treatment costs.Conclusions:In this cohort of PCa patients, treatment costs were highest for IMRT and SBRT, followed by RALP, HIFU, LDBT, Cryo, and RRP. The number of treatment sessions was a significant predictor of higher costs.
背景：本研究旨在从医疗系统角度，比较开放耻骨后根治性前列腺切除术（RRP）、机器人辅助根治性前列腺切除术（RALP）、调强放射治疗（IMRT）、低剂量近距离放射治疗（LDBT）、立体定向体部放疗（SBRT）、冷冻治疗（Cryo）和高强度聚焦超声（HIFU）治疗低/中危前列腺癌（PCa）的成本。 方法：这项经机构审查委员会批准的回顾性研究，比较了2018年1月至2019年12月期间杜克大学医院局部前列腺癌主要治疗方式的成本和费用。我们通过查询杜克大学财务系统的相关疾病、操作和收费代码来确定病例。连续病例中，具有NCCN高危疾病、既往接受过治疗或缺少机构财务信息的病例被排除在外。成本计算从选定治疗方案开始，直至最后一次治疗（SBRT和IMRT）或出院（其他治疗方式）。除RRP外，所有治疗方式均被视为技术密集型。 结果：共有552名平均年龄为65.0岁的患者符合纳入标准。NCCN风险分类包括85例（13%）低危、218例（41%）有利中危和249例（46%）不利中危病例。RALP、RRP、Cryo和HIFU为单次治疗，而IMRT、SBRT和LDBT为多次治疗。IMRT和SBRT是最昂贵的治疗方式，其次是RALP、HIFU、LDBT、Cryo和RRP。治疗次数（ρ = 0.55，p < 0.001）和技术密集型属性（ρ = 0.58，p < 0.001）与治疗成本显著相关。 结论：在该前列腺癌患者队列中，IMRT和SBRT的治疗成本最高，其次是RALP、HIFU、LDBT、Cryo和RRP。治疗次数是成本升高的重要预测因素。
肿瘤(癌症)患者之家