Healthcare costs among men with favorable risk prostate cancer managed with observation strategies versus immediate treatment in an integrated healthcare system

Figures & data

Figure 1. Study sample collection criteria. PCa: Prostate Cancer; PSA: Prostate Specific Antigen; GHP: Geisinger Health Plan; OBS: Observation Strategies; IMT: Immediate Treatment.

Table 1. Socio-demographic and clinical characteristics of prostate cancer patients at baseline in OBS vs IMT cohort (n = 352)

	OBS (n = 70)		IMT (n = 282)		p-value
	n	%	n	%
Age (Mean, SD)	68.4	8.7	64.62	8.35	<.01
Age group
40–64	22	31.4%	132	46.81%	.02
65+	48	68.6%	150	53.19%	.02
Race
White	70	100.0%	280	99.29%	.48
Black or African American	0	0.0%	1	0.35%	.62
Unknown	0	0.0%	1	0.35%	.62
Marital status
Single	3	4.3%	13	4.61%	.91
Married	52	74.3%	234	82.98%	.10
Widowed	9	12.9%	22	7.80%	.18
Divorced	5	7.1%	12	4.26%	.31
Separated	1	1.4%	1	0.35%	.28
Insurance status
Medicare	2	2.9%	7	2.48%	.86
Veterans Affairs	0	0.0%	1	0.35%	.62
Commercial	68	97.1%	274	97.16%	.99
Comorbid indices
CCI score	0.9	1.6	0.6	1.0	.13
0	40	57.1%	179	63.5%	.33
1	15	21.4%	57	20.2%	.82
2+	15	21.4%	46	16.3%	.31
Comorbid conditions
Hypertension	39	55.7%	125	44.3%	.09
Diabetes	15	21.4%	43	15.2%	.21
COPD	8	11.4%	19	6.7%	.19
Congestive Heart Failure	1	1.4%	7	2.5%	.60
Benign Prostatic Hyperplasia	34	48.6%	127	45.0%	.60
Tobacco history
Current every-day smoker	11	15.7%	38	13.5%	.63
Former smoker	28	40.0%	112	39.7%	.97
Never smoker	24	34.3%	97	34.4%	.99
Passive smoke exposure, never smoker	0	0.0%	3	1.1%	.39
Unknown	7	10.0%	32	11.3%	.75
Body Mass Index
Underweight (<18.5)	1	1.4%	1	0.4%	.28
Normal (18.5–24.9)	7	10.0%	34	12.1%	.63
Overweight (25.0–29.9)	30	42.9%	113	40.1%	.67
Obese (≥3 0)	20	28.6%	93	33.0%	.48
Unknown	12	17.1%	41	14.5%	.59
Treatment strategy
Active Surveillance	18	25.7%	0	0.0%
Watchful Waiting	8	11.4%	3	1.1%
Immediate Treatment	32	45.7%	266	94.3%
Unknown	12	17.1%	13	4.6%
Family history of prostate cancer
Yes	15	21.4%	79	28.0%	.27
No	39	55.7%	145	51.4%	.52
Unknown	16	22.9%	58	20.6%	.67
Prostate cancer characteristics
Index PSA (Mean, SD)	5.8	2.5	5.7	2.4	.72
<4 ng/mL	13	0.2	56	19.9%	.81
4–10 ng/mL	53	0.8	202	71.6%	.49
>10 ng/mL	4	0.1	19	6.7%	.76
Unknown	0	0.0	5	1.8%	.26
Index Total Gleason Score (Mean, SD)	6.3	0.5	6.3	48.3%	.40
Index Total Gleason Score = 6	49	0.7	183	64.9%	.42
Index Total Gleason Score = 7	20	0.3	98	34.8%	.33
Risk category
Low-risk	45	64.3%	164	58.2%	.35
Intermediate-risk	24	34.3%	115	40.8%	.32

OBS: observation; IMT: immediate treatment; PSA: Prostate specific antigen; SD: Standard Deviation; CCI: Charlson Comorbidity Index; COPD: Chronic Obstructive Pulmonary Disease.

D’AMICO risk categories definition: Low-risk patients: T1–T2A, PSA level ≤10 ng/mL and Gleason score ≤6.

Figure 2. Prostate Cancer-related Health Care Costs among PCa Patients for the Main, Sensitivity, and Subgroup Analyses for the First 3 Years.

Table 2. Adjusted PCa-related healthcare costs among PCa patients in OBS vs IMT using generalized linear models.^a

PCa-related healthcare costs	OBS (n = 70) Mean	IMT (n = 282) Mean	p-value
First year
Outpatient	$7,152	$14,322	<.001
Inpatient	$1,854	$4,242	.005
Total	$9,491	$19,943	<.001
First 2 years
Outpatient	$10,538	$15,735	<.001
Inpatient	$3,200	$4,689	.223
Total	$14,111	$21,636	<.001
First 3 years
Outpatient	$12,126	$16,880	.002
Inpatient	$3,404	$5,310	.145
Total	$15,785	$23,177	<.001

OBS: observation; IMT: immediate treatment; PCa: prostate cancer

^a GLM model adjusted for: treatment cohorts (OBS and IMT), age, race, marital status, insurance type, Charlson comorbidity index score, comorbid conditions, smoking status, BMI, family history of prostate cancer, D’Amico risk categories, index PSA and index Gleason score.