The long-term costs of managing prostate cancer

We now know how much it cost the Province of Ontario, in Canada, on average, to manage prostate cancer cases between 1995 and 2002. However, it is doubtful that these data would necessarily be applicable to the same time period in the USA or other nations.

Krahn et al. set out to estimate the total healthcare costs and the costs specifically attributable to prostate cancer across all stages of disease, and to determine the predictors of those costs.

By using linked administrative data available within the Canadian healthcare system for the Province of Ontario, they were able to estimate the direct medical costs for 42,484 men diagnosed with prostate cancer between 1995 and 2002. And in order to estimate costs over time, they divided the process of patient care into five phases:

  • Phase I: the 6-month period leading up to and inclusive of biopsy and diagnosis
  • Phase II: the 12 months of initial care and immediate post-treatment recovery (if actual treatment was needed and given)
  • Phase III: continuing care
  • Phase IV: the 12-month period of “pre-terminal care” (lasting from 18 to 6 months prio to death)
  • Phase V: the 6-month period of terminal care (up to and including the patient’s death).

Using these time periods, they estimated that the total direct costs for each phase of the disease (in Canadian dollars) were as follows:

  • Phase I: C$1,297 per 100 days
  • Phase II: C$3,289 per 100 days
  • Phase III: C$1,495 per 100 days
  • Phase IV: C$5,629 per 100 days
  • Phase V: C$16,020

They were also able to show that prostate cancer-attributable costs accounted for 72 percent of total costs in the 12-month period after diagnosis (Phase II, C$2,366), but < 35 percent of total costs in phases III to V (C$398, C$1,977 and C$3,140, respectively).

An advanced stage at diagnosis, being older at diagnosis, and higher comorbidity were all associated with increased costs.

Not surprisingly, prostate cancer is associated with increasing direct healthcare costs over the natural history of the disease, and costs are highest around two events — cancer diagnosis and cancer death.

Naturally, the nature of the Canadian “single payer” healthcare system affects not only what these costs are, but also how these costs are calculated, so it would not be wise to assume that there costs would necessarily correlate with the costs of prostate cancer care under other systems — particularly systems like that in the USA which are based on a very different, multi-payer environment.

2 Responses

  1. By contrast, going through Phases I thru V in the U.S. has been estimated to cost a total of between $1 and $1.5 million.

    Until the U.S. adopts reforms that regulate costs and profits at every level (drug and equipment manufacturers, insurance companies, pharmacies, hospitals and doctors, etc.) costs here will continue to spiral up while more and more people in need of medical care spiral down into not being able to access or afford the care they need. A pox on the people who are shouting nonsense at town meetings and a plague on those who are funding and organizing them.
    It is time for the U.S. to join the civilized world by adopting universal national health care!

  2. Long-term care insurance is a wise option for anyone with assets to protect from a $75,000 per year unexpected nursing home visit.

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