Prostate Cancer Study Rekindles Price Transparency Debate

Price transparency issues continue to hound healthcare. With the increasingly high costs of treatment in cancer, and the growing emphasis on the value of care, monitoring healthcare costs for variation could improve efficiency and clinical effectiveness. New research, published in the journal Cancer, evaluated the short-term and long-term costs of treating patients with low-risk prostate cancer across the entire care spectrum. A detailed analysis of each step, starting at the point of diagnosis and during the entire 12-year follow-up period, identified significant cost variation between competing treatments.

The method developed by the authors, called the time-driven activity-based costing (TDABC), generated process maps for each phase of patient care. These treatments included:

· initial urologic visit

· robotic-assisted laparoscopic prostatectomy (RALP)

· cryotherapy

· high-dose rate (HDR) and low-dose rate (LDR) brachytherapy

· intensity-modulated radiation therapy (IMRT)

· stereotactic body radiation therapy (SBRT)

· active surveillance (AS)

At the 5-year follow-up following diagnosis, while AS cost an average of $7298, IMRT was priced at about $23,000. These numbers, the authors write, stayed consistent through the 12-year study period. LDR brachytherapy was an average of about $9000, cheaper than HDR brachytherapy and SBRT, each costing over $11,000. RALP was nearly $17,000 (a combination of inpatient stay and equipment cost), cryotherapy about $11,000.

According to Aaron Laviana, MD, the first author on the study, “Traditional costing methods often lack transparency and can be arbitrary, preventing the true costs of a disease or treatment from being understood. This is important, as patients often receive a hospital bill with arbitrary charges that may or may not reflect their true treatment costs. This costing methodology creates an algorithm that allows organizations to assess their costs and see where they may be able to improve. Altogether, by maintaining similar quality, this will improve the overall value of care delivered.”

The next step for the research team is to link costs with outcomes and quality of care, to assess which treatments present the most value to the patient.