Significant financial differences of chemical and surgical androgen deprivation in a contemporary cohort.

Autor:	Paul CJ; Department of Urology, University of Iowa Hospitals & Clinics, Iowa City, IA, USA., Garje R; Holden Comprehensive Cancer Center, University of Iowa Hospitals & Clinics, Iowa City, IA, USA., Kreder KJ; Department of Urology, University of Iowa Hospitals & Clinics, Iowa City, IA, USA., Mott SL; Holden Comprehensive Cancer Center, University of Iowa Hospitals & Clinics, Iowa City, IA, USA., Gellhaus PT; Department of Urology, University of Iowa Hospitals & Clinics, Iowa City, IA, USA.
Jazyk:	angličtina
Zdroj:	Translational andrology and urology [Transl Androl Urol] 2022 Sep; Vol. 11 (9), pp. 1252-1261.
DOI:	10.21037/tau-22-191
Abstrakt:	Background: Androgen deprivation therapy (ADT) remains a cornerstone of treatment for advanced prostate cancer. Few men elect for surgical castration via bilateral orchiectomy. We sought to compare the relative difference in financial charges between chemical and surgical ADT in men. Methods: Billing data was obtained for patients with metastatic prostate cancer receiving chemical ADT and who had bilateral orchiectomy from 2014-2019. Men had chosen intervention based on personal preference. We compared charges of ADT administration for chemical ADT and overall charges for bilateral orchiectomy. We determined the time chemical ADT patient charges surpassed those of surgical charges, as well as the net present value (NPV) of hypothetical savings for electing surgery over various ADT agents. Results: One hundred and thirty-seven patients receiving chemical ADT and 7 patients who had undergone bilateral orchiectomy were analyzed. Median and mean surgical charges were $13,000. By 38 weeks following treatment initiation, 50% of chemical ADT patients had surpassed surgical charges, with 95% at 2 years. The NPV in savings for a median patient varied between ADT agent and was highest at $167,000 for leuprolide. Conclusions: In less than a year, the median chemical ADT patient charges were greater than surgical castration. The NPV of electing surgery over ADT was the highest with leuprolide. Despite under-utilization, surgical castration remains a medically appropriate and cost-effective option for permanent ADT. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-22-191/coif). The authors have no conflicts of interest to declare. (2022 Translational Andrology and Urology. All rights reserved.)
Databáze:	MEDLINE
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