Prostate Cancer Testing, Treatment in Older Men Costs Medicare Estimated $1.2 Billion

The US Preventive Services Task Force recommends against routine screening for prostate cancer in men 70 years of age and older.

Prostate cancer is the second leading cause of cancer death among American men, behind lung cancer, according to the American Cancer Society. Although the disease can be serious, it is typically slow-growing and may not require aggressive treatment, especially in older men.

Because of this, the US Preventive Services Task Force currently recommends against routine screening for prostate cancer in men 70 years of age and older, citing that the potential benefits do not outweigh the harms for this age group.

A new report published in JAMA Oncology highlights the cost burden of utilizing prostate cancer screening and treatment in this age group. According to the findings, screening and treatment for prostate cancer in men above the age of 70 are estimated to cost Medicare more than $1.2 billion over a 3-year period for each group of men diagnosed.

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Screening and treatment for the disease in men above age 70 can cause unnecessary harm and adverse effects. The new findings indicate that forgoing screening and treatment for those who would not benefit could reduce health care costs, according to the study.

Researchers from the University of North Carolina Lineberger Comprehensive Cancer Center examined the costs associated with screening for prostate cancer, including treatment, for 3 years after diagnosis. They used the National Cancer Institute Surveillance, Epidemiology, and End results (SEER)-Medicare linked claims database to analyze costs related to diagnosis and work-up, treatment, follow-up, and adverse effect management. The data included nearly 50,000 men 70 years of age or older who were diagnosed with prostate cancer between 2004 and 2007.

For men diagnosed from 2004 to 2007, the total cost for treating and screening each group was estimated to be $1.2 billion. Additionally, the researchers found that $451 million was spent on men who were diagnosed with prostate cancer that is graded with a Gleason score of 6, which is considered to be low-grade disease and best managed using active surveillance rather than aggressive treatment. The median per-patient cost within 3 years after diagnosis was $14,453, with treatment costs accounting for 73% of that total.

According to the researchers, choosing active surveillance for patients with low-grade disease as opposed to aggressive treatment could save Medicare an estimated $320 million per year.

The researchers noted that testing and treating prostate cancer in older individuals for whom the potential harms outweigh the potential benefits may have little to no impact on their life expectancy.

“Not following the guidelines could be putting people’s health at risk, and it is costing the US health care system a lot of money,” study author Ronald C. Chen, MD, MPH, associate professor in the UNC School of Medicine Department of Radiation Oncology, said in a press release about the findings. “It would make more sense to put these resources into other areas that could do more good for patients.”

Because the diagnosis and treatment of prostate cancer among older men contributes substantial cost to the Medicare program, the researchers concluded that reducing provisions of low-value health care services among this patient population could result in significant savings.

References

American Cancer Society. Key Statistics for Prostate Cancer. https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html. Accessed September 13, 2018.

Prostate cancer care for older men estimated to cost Medicare $1.2B [news release]. UNC Lineberger’s website. http://unclineberger.org/news/prostate-cancer-care-for-older-men. Accessed September 13, 2018.

Trogdon JG, Falchook AD, Basak R, et al. Total Medicare costs associated with diagnosis and treatment of prostate cancer in elderly men. JAMA Oncology. 2018. Doi: 10.1001/jamaoncol.2018.3701