Cost Comparison Between Watchful Waiting With Active Surveillance and Active Treatment of Clinically Localized Prostate Cancer

OBJECTIVES In part because of concern regarding overtreatment in men with prostate cancer, watchful waiting with active surveillance (WWAS) has been increasingly used in men diagnosed with low-risk prostate cancer. The present study investigates the difference in costs between men with low-risk prostate cancer treated with up-front radical prostatectomy (RP) versus WWAS. METHODS A cost model was constructed using data from centers that have published their results in men who were followed up with WWAS compared with the actual costs of up-front RP calculated from a high volume center. Two WWAS arms of 15-year duration were created in which the follow-up protocol and conversion rate to active treatment were varied. RESULTS The cost of up-front RP including costs of surgery, complications, and follow up for 15 years was $15 235 per person. Costs of WWAS were estimated using annual conversion rates from WWAS to RP of both 5% and 7%. Costs per person in the WWAS arms ranged from $6558 to $11 992 in the scenarios created which represent a 43%-78.7% reduction in costs when compared with men undergoing up-front RP. CONCLUSIONS Watchful waiting with active surveillance is being increasingly used in hopes of decreasing the potential overtreatment of prostate cancer in men with low-risk disease. The present study suggests that WWAS is likely to markedly decrease costs when compared with active treatment with RP. UROLOGY 76: 703-709, 2010. (C) 2010 Elsevier Inc.