Evaluating Treatments and Corresponding Costs of Prostate Cancer Patients Treated Within an Inpatient or Hospital-based Outpatient Setting

Brian Seal; Sean D Sullivan; Scott Ramsey; Carl V Asche; Kenneth M Shermock; Syam Sarma; Erin Zagadailov; Eileen Farrelly; Michael Eaddy


Future Oncol. 2015;11(3):439-447. 

In This Article


The purpose of this study was to describe treatments used and the associated cost of care for patients who have received PCa-related treatment in a hospital setting, which included inpatient stays and hospital-based outpatient visits. More specifically, this study provides a baseline of current treatment patterns and costs to which emerging patterns may be compared. This is particularly relevant to hospital administrators and clinicians who will seek to determine how the recent entrance of several novel agents (abiraterone acetate, cabazitaxel, radium-223 and enzalutamide) will impact or alter current treatment patterns.

The primary variables of interest were treatments utilized during the encounter, the corresponding costs of treatments per encounter and length of stay. The average cost per encounter for inpatient stays was US$12,286, with the majority of treatment-related costs associated with surgery. In contrast, the average cost per outpatient visit was US$4364, with the majority of treatment-related costs associated with radiation. These results are consistent with a previous retrospective study of PCa patients by Crawford et al., who reported that surgery was the most common treatment among PCa patients.[14] Additionally, the majority of costs were due to inpatient resource utilization for patients who received surgery. The large proportion of outpatient stays associated with radiation therapy may be explained by recent findings from SEER by Nguyen et al. In a year-by-year analysis of utilization from 2002 to 2005, Nguyen et al. found rapidly increasing use of external radiation and supplemental intensity-modulated radiation therapy for patients receiving brachytherapy.[15]

With respect to cost per encounter, our findings were similar to those found in the National Inpatient Sample (NIS) by the HCUP on PCa in 2004.[12] On average, the mean cost per hospitalization in the HCUP sample was US$8100 in 2004, which is lower than our finding of US$12,286 per hospitalization; however this may be related to a shorter length of stay with the HCUP database (3.4 vs 4.4 days). Additionally, the marginally higher average cost per encounter in our analysis may also be related to the substantial number of patients who received multimodal therapy. In our study, nearly one in three encounters in an inpatient setting and one in five encounters in an outpatient setting were associated with the receipt of two or more treatments between 2006 and 2010. This is in contrast to Crawford et al., who reported less than 1% of PCa patients received multiple treatments between 2000 and 2005.[14] Although the unit of analysis for the Crawford paper was different (patient) than our analysis (encounter), our analysis indicates that patients may continue to seek and receive multiple treatments, which will add to already heightened attention to control costs in a hospital setting.

Last, our results showed that the majority of men with PCa treated in an inpatient setting received surgery or some form of hormone therapy. These findings are consistent with current treatment paradigms and indicate that the inpatient-treated PCa population in this study may represent a population with advanced disease, symptomatic disease or at a high risk for recurrence. Watchful waiting or active surveillance is common until progressive or symptomatic disease is evident, upon which treatment options such as surgery may be employed.[5] Additionally, primary hormonal therapy is a first-line treatment option for advanced PCa, which is often regarded as palliative treatment.