Korea Journal of Hospital Management (한국병원경영학회지)

Korean Society of Hospital Management (한국병원경영학회)
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Cost Comparison of Androgen Deprivation Therapy and Radical Prostatectomy for Prostate Cancer

전립선암의 남성호르몬 박탈 치료와 근치적 전립선적출술의 비용 분석

  • Kim, Jang Mook (Department of Health Administration, College of Health Science, Dan Kook University of Korea) ;
  • Rho, Mi Jung (Department of Medical Informatics, College of Medicine, The Catholic University of Korea) ;
  • Jang, Kwang Soo (Department of Information System, Hanyang University) ;
  • Park, Yong Hyun (Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lee, Ji Youl (Department of Medical Informatics, College of Medicine, The Catholic University of Korea) ;
  • Choi, In Young (Department of Medical Informatics, College of Medicine, The Catholic University of Korea)
  • 김장묵 (단국대학교 보건과학대학 보건행정학과) ;
  • 노미정 (가톨릭대학교 성의교정 의과대학 의료정보학교실) ;
  • 장광수 (한양대학교 공과대학 정보시스템학과) ;
  • 박용현 (가톨릭대학교 성의교정 의과대학 비뇨의학교실) ;
  • 이지열 (가톨릭대학교 성의교정 의과대학 의료정보학교실) ;
  • 최인영 (가톨릭대학교 성의교정 의과대학 의료정보학교실)
  • Received : 2018.05.14
  • Accepted : 2018.09.14
  • Published : 2018.09.30
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Abstract

Purpose: To evaluate the medical expenditures for prostate cancer patients, including out-of-pocket costs, and compared the costs between androgen deprivation therapy and radical prostatectomy treatment. Methodology: This study combined clinical data from 357 prostate cancer patients from the Smart Prostate Cancer Database and the medical expenditure data from the claims and cost databases. We used the independent two-sample t-tests to compare androgen deprivation therapy and radical prostatectomy. Multivariable logistic regression analysis was conducted to identify determining factors for androgen deprivation therapy and radical prostatectomy treatments. Findings: The medical costs of androgen deprivation therapy treatment were much lower than radical prostatectomy treatment at the one year and remained lower until the fourth-year. However, after four years, the accumulated medical expenditures of androgen deprivation therapy become significantly higher than radical prostatectomy treatment. Patients with a higher cancer stage and older age had higher chances of being treated using androgen deprivation therapy treatment than radical prostatectomy treatment. Practical Implications: Our results show that early detection of cancer reduces the treatment cost for both patients and insurance payers. It also demonstrates that cost comparisons should be conducted over long periods of time in order to most accurately assess the costs.

Purposes: 본 연구는 전립선암 환자의 의료비 지출을 평가하기 위해 남성호르몬 박탈 치료와 근치적 전립선적출술의 비용을 비교하였다. Methods: 본 연구는 스마트 전립선암 데이터베이스(Smart Prostate Cancer Database)의 전립선암 환자 357명의 데이터와 청구데이터베이스에서 의료비 관련 데이터를 도출하였다. 근치적 전립선적출술과 남성호르몬 박탈 치료간 비교를 위해 독립표본 t검정을 실시하였다. 또한 남성호르몬 박탈 치료와 근치적 전립선적출술에 영향을 미치는 요인을 검증하기 위해 다중회귀 분석을 실시하였다. Findings: 치료 후 1년까지 남성호르몬 박탈치료가 근치적 전립선적출술 보다 비용이 낮은 것으로 나타났으며, 치료 후 4년까지 낮게 유지되었다. 그러나 4년이 지나면 남성호르몬 박탈 치료의 누적의료비가 근치적 전립선적출술보다 더 유의미하게 높게 나타났다. 환자의 병기가 높거나 나이가 많은 경우 근치적 전립선적출술보다 남성호르몬 박탈 치료를 할 확률이 더 높았다. Practical Implications: 본 연구는 조기 암 발견이 환자 뿐 아니라 국민건강보험공단의 의료비를 줄일 수 있다는 것을 보여 준다. 또한 의료비를 정확히 평가하기 위해서는 오랜 기간의 정보를 평가해야 하며, 이를 기반으로 평가 및 예측이 필요함을 증명하였다.

Keywords

References

  1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA: A Cancer Journal for Clinicians. 2013;63(1):11-30. doi: 10.3322/caac.21166.
  2. Jung KW, Won YJ, Kong HJ, et al. Cancer statistics in Korea: incidence, mortality, survival and prevalence in 2010. Cancer Res Treat. 2013;45(1):1-14. doi: 10.4143/crt.2013.45.1.1. PubMed PMID: 23613665; PubMed Central PMCID: PMC3629358.
  3. Potters L, Klein EA, Kattan MW, Reddy CA, Ciezki JP, Reuther AM, et al. Monotherapy for stage T1-T2 prostate cancer: radical prostatectomy, external beam radiotherapy, or permanent seed implantation. Radiotherapy and Oncology. 2004;71(1):29-33. doi: http://dx.doi.org/10.1016/j.radonc.2003.12.011.
  4. Kupelian PA., Buchsbaum JC., Patel C, Elshaikh M, Reddy, CA., Zippe C., et al. Impact of biochemical failure on overall survival after radiation therapy for localized prostate cancer in the PSA era. International Journal of Radiation Oncology Biology Physics 52.3. 2002;704-711. https://doi.org/10.1016/S0360-3016(01)02778-X
  5. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, et al. EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing, and castration-resistant prostate cancer. European urology. 2014;65(2):67-79.
  6. Shin, Bosung, Taek Won Kang. Quality of Life in Prostate Cancer Patient Undergoing Androgen Deprivation Therapy. Korean Journal of Urological Oncology 14.1. 2016;10-17.
  7. Bolenz C, Gupta A, Hotze T, Ho R, Cadeddu JA, Roehrborn CG, et al. Cost comparison of robotic, laparoscopic, and open radical prostatectomy for prostate cancer. European urology. 2010;57(3):53-8. https://doi.org/10.1016/j.eururo.2010.02.034
  8. Bolenz C, Freedland SJ, Hollenbeck BK, Lotan Y, Lowrance WT, Nelson JB, et al. Costs of radical prostatectomy for prostate cancer: a systematic review. European urology. 2014;65(2):316-24. https://doi.org/10.1016/j.eururo.2012.08.059
  9. Hohwu L, Borre M, Ehlers L, Venborg Pedersen K. A short-term cost-effectiveness study comparing robot-assisted laparoscopic and open retropubic radical prostatectomy. Journal of medical economics. 2011;14(4):403-9. https://doi.org/10.3111/13696998.2011.586621
  10. Link RE, Su L-m, Bhayani SB, Pavlovich CP. Making ends meet: a cost comparison of laparoscopic and open radical retropubic prostatectomy. The Journal of urology. 2004;172(1):269-74. https://doi.org/10.1097/01.ju.0000128773.99707.5b
  11. Tomaszewski JJ, Matchett JC, Davies BJ, et al. Comparative hospital cost-analysis of open and robotic-assisted radical prostatectomy. Urology. 2012;80(1):126-9. https://doi.org/10.1016/j.urology.2012.03.020
  12. Anderson JK, Murdock A, Cadeddu JA, Lotan Y. Cost comparison of laparoscopic versus radical retropubic prostatectomy. Urology. 2005;66(3):557-60. https://doi.org/10.1016/j.urology.2005.04.016
  13. Silverstein AD, Weizer AZ, Dowell JM, et al. Cost comparison of radical retropubic and radical perineal prostatectomy: single institution experience. Urology. 2004;63(4):746-50. https://doi.org/10.1016/j.urology.2003.11.007
  14. Nguyen PL, Gu X, Lipsitz SR, Choueiri TK, Choi WW, Lei Y, et al. Cost implications of the rapid adoption of newer technologies for treating prostate cancer. Journal of Clinical Oncology. 2011:JCO. 2010.31. 1217. https://doi.org/10.1200/JCO.2010.31.1217
  15. Sugihara T, Yasunaga H, Horiguchi H, Tsuru N, Ihara H, Fujimura T, et al. Comparisons of perioperative outcomes and costs between open and laparoscopic radical prostatectomy: A propensity-score matching analysis based on the Japanese Diagnosis Procedure Combination database. International Journal of Urology. 2013;20(3):349-53. https://doi.org/10.1111/iju.12079
  16. Yasunaga H, Sugihara T, Imamura T. Difference in willingness-to-pay for prostate cancer screening between ill-informed and well-informed men: a contingent valuation survey. Urology. 2011;77(6):1325-9. https://doi.org/10.1016/j.urology.2011.02.025
  17. Satoh T, Ishiyama H, Matsumoto K, Tabata K, Kitano M, Iwamura M, et al. Cost comparison of curative therapies for localized prostate cancer in Japan: a single-institution experience. Jpn J Radiol. 2009;27(9):348-54. doi: 10.1007/s11604-009-0356-x. PubMed PMID: 19943145.
  18. Choi IY, Park S, Park B, Chung BH, Kim C-S, Lee HM, et al. Development of prostate cancer research database with the clinical data warehouse technology for direct linkage with electronic medical record system. Prostate international. 2013;1(2):59-64. https://doi.org/10.12954/PI.12015
  19. Huh SW, Shetty AA, Kim JM, Cho M-L, Kim SA, Yang S, et al. Autologous bone marrow mesenchymal cell induced chondrogenesis for the treatment of osteoarthritis of knee. Tissue Engineering and Regenerative Medicine. 2016;13(2):200-9. https://doi.org/10.1007/s13770-016-9125-y
  20. Kim JM, Han JR, Shetty AA, et al. Comparison between total knee arthroplasty and MCIC (autologous bone marrow mesenchymal-cellinduced-chondrogenesis) for the treatment of osteoarthritis of the knee. Tissue Engineering and Regenerative Medicine. 2014;11(5):405-13. https://doi.org/10.1007/s13770-014-0041-8