LAUSR

BACKGROUND Recent trends in payer and patient preferences increasingly incentivize time-efficient (≤2 weeks treatment time) prostate cancer treatments. METHODS National Medicare claims from Jan 1, 2011 through Dec 31, 2014 were analyzed to identify newly diagnosed prostate cancers. Three 'radical treatment' cohorts were identified (prostatectomy, brachytherapy, and stereotactic body radiation therapy [SBRT]) and matched to an active surveillance (AS) cohort by using inverse probability treatment weighting (IPTW) via propensity score. Total costs at 1 year after biopsy were calculated for each cohort, and treatment-specific costs were estimated by subtracting total 1-year costs in each radical treatment group from those in the AS group. RESULTS Mean 1-year adjusted costs were highest among patients receiving SBRT ($26,895), lower for prostatectomy ($23,632), and lowest for brachytherapy ($19,980), whereas those for AS were $9,687. Costs of radical modalities varied significantly by region, with the Mid-Atlantic and New England regions having the highest cost ranges (>$10,000) and the West South Central and Mountain regions the lowest range in costs (<$2,000). Quantification of toxic effects showed that prostatectomy was associated with higher Genitourinary (GU) incontinence (HR=10.8 compared with AS) and sexual dysfunction (HR=3.5), whereas the radiation modalities were associated with higher GU irritation/bleeding (Brachytherapy HR=1.7; SBRT HR=1.5) and Gastrointestinal (GI) ulcer/stricture/fistula (Brachytherapy HR=2.7; SBRT HR=3.0). Overall mean toxicity costs were highest among patients treated with prostatectomy ($3,500) followed by brachytherapy ($1,847), SBRT ($1,327), and AS ($1,303). CONCLUSION Time-efficient treatment techniques exhibit substantial variability in toxicity and costs. Furthermore, geographic location substantially influenced treatment costs.