Originally published 1/9/2014
Rising healthcare costs are even more concerning today than in 2014, when we posted the blog below. At the same time, advances in medical technology have continued at a steady pace. This is especially true for the ever-increasing applications of multiparametric MRI (mpMRI) in prostate cancer detection, diagnosis and treatment. Not only has mpMRI improved benefits to patients, cost/benefit calculations can point the way toward saving healthcare dollars.
A great example is an October, 2020 published analysis, “Toxicity reduction required for MRI-guided radiotherapy to be cost-effective in the treatment of localized prostate cancer.”[i] External beam radiation therapy is more expensive than radical prostatectomy, and can lead to both short-term and late-onset damage (toxicities) to urinary, sexual, and bowel function. Toxicity adds to the overall cost of radiation treatment over time, due to the added medical care involved in treating the side effects. Image guidance can assist with better targeting of radiation modalities such as stereotactic body radiation therapy (SBRT). Greater precision results in less toxicity, which in turn lowers post-radiation costs. According to the authors, “The costs and quality adjusted life years (QALYs) saved with toxicity reduction were juxtaposed with the cost increase of MR-IGRT to determine toxicity reduction thresholds for cost-effectiveness.” They concluded that from a healthcare perspective, MRI-guided radiation therapy “can reasonably be expected to be cost-effective.”
Since radiation therapy will continue to be a treatment option for localized prostate cancer patients who cannot or do not wish to have surgery, the addition of MRI guidance will help lower the long-range cost of this expensive treatment modality.
What makes a prostate cancer treatment worth the dollars spent on it? I asked myself this question after coming across two online articles posted in January 2012. One article questions the high price tag associated with proton beam radiation for prostate cancer. The other asks if robotic prostatectomy is overhyped. Is it purely coincidence that both of these articles appeared within 10 days of each other, or is it a sign of a growing discontent with pricey therapies that don’t always deliver as promised?
The first article has a provocative title, “It Costs More, but Is It Worth More?”1 The authors point out that proton beams use hugely expensive particle accelerator technology, which theoretically focuses atomic nuclei more precisely on tumors than conventional radiation. When used to treat prostate cancer, Medicare pays about twice as much ($50,000) as other types of radiotherapy.
Proton beam therapy appears to be most cost effective against rare childhood brain and spinal cord cancers. However, currently there are not enough of these and other rare cases to keep the nine U.S. proton beam centers in full use. So some centers are promoting this therapy as a treatment for prostate cancer. The problem is that there is no long-term data supporting the results (effectiveness and side effects) of treating prostate cancer with proton beam. In my mind the high reimbursement rate for a treatment with no proven advantages makes little sense. Why spend precious healthcare dollars for something that should be in clinical trials supported by industry and research grants until we know more about it?
The second article, “Is Robotic Prostatectomy Overhyped?” also caught my eye. It reports a research study of 685 Medicare patients who had either open or robotic prostatectomy from August to December in 2008. The comparison results are revealing. The researchers “…reported no difference in sexual performance and incontinence risks between the 2 approaches…”2 The article circles around to the issue of healthcare costs. As in the proton beam article, the issue is whether robotic prostatectomy offers clear benefits over other techniques. An editorial that accompanied the published study suggested, “The increased use of robotic technology may not be primarily driven by such benefits but rather by heavy marketing, whether by the company that produces the technology, by hospitals that have acquired it or by physicians who promote it to gain market share.” 3
I believe in U.S. medical science and medical practice. I also believe in my personal mission to optimize men’s prostate health by offering advanced MRI-guided diagnostics and MRI-guided targeted treatments. In our center, if early-stage prostate tumors are found and the patient is appropriate, we offer men a range of minimally invasive, cost effective ablative treatments designed to target and destroy the cancer while preserving continence and potency. And based on results we are seeing, I am convinced we are on the right track in two crucial areas: combating disease, and combating the wasteful spending for costly treatment options that may come with a higher risk of hidden, lifestyle costs.
At the Sperling Prostate Center we are working to confront today’s dilemmas of prostate health by offering men targeted MRI-Guided diagnostics and MRI-Guided treatments that represent the clinical and economic future of medicine.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
[i] Schumacher L, Dal Pra A, Hoffe SE, Mellon EA. Toxicity reduction required for MRI-guided radiotherapy to be cost-effective in the treatment of localized prostate cancer. Br J Radiol. 2020 Oct 1;93(1114):20200028.
[ii] >Emanuel, Ezekiel J. and Pearson, Steven D.. It costs more, but it is worth more?. http://opinionator.blogs.nytimes.com/2012/01/02/it-costs-more-but-is-it-worth-more/?scp=2&sq=ezekiel%20emanuel&st=cse . 1. 2. (2012).
[iii] Cook, Daniel. Is robotic prostatectomy overhyped?. http://www.outpatientsurgery.net/news/2012/01/9-Is-Robotic-Prostatectomy-Overhyped . 1. 10. (2012).
[iv] Cooperberg M et al. Outcomes for radical prostatectomy: is it the singer, the song, or both?. Journal of Clinical Oncology. http://jco.ascopubs.org/content/early/2012/01/03/JCO.2011.38.9593 . 1. 3. (2012).