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The burden of out‐of‐pocket and indirect costs of prostate cancer
Author(s) -
Jayadevappa Ravishankar,
Schwartz J. Sanford,
Chhatre Sumedha,
Gallo Joseph J.,
Wein Alan J.,
Malkowicz S. Bruce
Publication year - 2010
Publication title -
the prostate
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.295
H-Index - 123
eISSN - 1097-0045
pISSN - 0270-4137
DOI - 10.1002/pros.21161
Subject(s) - medicine , prostate cancer , prostatectomy , confounding , sexual function , quality of life (healthcare) , indirect costs , prospective cohort study , prostate , cohort study , cohort , urology , gynecology , cancer , nursing , accounting , business
BACKGROUND Out‐of‐pocket and indirect (OPI) costs play an important role in prostate cancer (PCa) outcomes research. We sought to analyze OPI costs of newly diagnosed PCa patients receiving either radical prostatectomy (RP) or external beam radiation therapy (EBRT). METHODS Prospective cohort design was used to recruit 512 newly diagnosed PCa patients from urology clinics of an urban academic hospital and a Veterans Administration medical center. Participants provided demographic information and completed self‐reported generic and prostate‐specific Health Related Quality of Life (HRQoL) and indirect‐cost surveys at baseline and at 3, 6, 12, and 24 months follow‐up. Linear mixed models were applied to study the association between OPI costs, treatment and HRQoL outcomes. Propensity scores adjusted for potential confounders and Bonferroni correction was used to account for multiple testing. RESULTS Total mean OPI costs varied between RP group and EBRT group at 3‐month ($5576 vs. $2010), 6‐month ($1776 vs. $2133), 12‐month ($757 vs. $774), and at 24‐month follow‐up ($458 vs. $871). Linear mixed models indicated that RP was associated with lower medication costs (OR = 0.61, CI = 0.48–0.89) and total OPI costs (OR = 0.71, CI = 0.64–0.92). Total OPI costs were inversely related to most of the generic HRQoL items. Similarly, prostate‐specific HRQoL items of urinary function (OR = 0.72; adjusted‐CI = 0.58–0.84), bowel function (OR = 0.96; adjusted‐CI = 0.78–0.98), sexual function (OR = 0.85; adjusted‐CI = 0.72–0.92), urinary bother (OR = 0.79; adjusted‐CI = 0.67–0.83), and sexual bother (OR = 0.88; adjusted‐CI = 0.76–0.93) were inversely related to OPI costs. CONCLUSIONS OPI costs of PCa care are substantial and vary across time and treatment. Prostate 70: 1255–1264, 2010. © 2010 Wiley‐Liss, Inc.