Prostate cancer is costly for Californians, according to UCSF researchers

By Maureen McInaney

Prostate cancer, which largely afflicts older men, is costly for Californians, accounting for more than $180 million in direct health care costs in 1998 and an additional $180 million in lost productivity resulting from premature death. Costs are likely to increase as life expectancy increases, according to UCSF researchers.

“Because prostate cancer is costly and common, it is critical to identify cost-effective screening that will permit early detection,” said Wendy Max, PhD, co-director of the UCSF Institute for Health & Aging and professor of health economics, in a study that appears in the June 1, 2002 issue of Cancer.

The researchers noted that California hospitalization costs account for almost three-fifths of the total direct costs,  with Medicare and private health insurance sharing almost equally in paying for hospital care. The mean cost for a person hospitalized for prostate cancer was $6,939.  In addition, prostate cancer adds an average of $3,388 in costs for a patient hospitalized for another reason, such as heart disease or respiratory illness.

Other costs included emergency department visits, outpatient visits, office-based provider visits, prescription medications, home health care, nursing home care, and losses of productivity for those who died prematurely.

This cancer in Californians follows national patterns, according to the investigators.
Prostate cancer is the leading cause of cancer incidence among California men, accounting for 30.4 percent of all cancer cases.  A steep increase in annual incidence rates occurred between 1988-1992 with the introduction of screening for prostate specific antigen (PSA), which permitted diagnosis at earlier stages. 

Deaths due to prostate cancer ranked second to lung cancer and account for 12.2 percent of all cancer deaths in the California, they said.

“Although the number of deaths and new incident cases has declined recently, prostate cancer remains the most common malignancy among white, black, Hispanic, Filipino, Japanese, Chinese, and Asian Indian males,” said Max.
She explained that the single greatest risk factor for prostate cancer is age.

Prostate cancer incidence is 80 times higher in males age 85 and older compared with men age 40-45 years. The death rate for prostate cancer is 17.7 per 100,000 men for all ages. For men 75-84 years, the death rate was 248 per 100,000 men. For men 85 and older, the death rate more than doubled to 591 per 100,000 men. Other risk factors include positive family history, black racial identity, animal fat consumption, and specific genetic variations.

This study estimated both direct and indirect costs of prostate cancer in California for 1998. Researchers analyzed California specific hospitalization and mortality data. Direct costs were categorized according to the setting in which the cost was incurred. For example, if a patient received radiation treatment as an inpatient, then it was considered a hospitalization cost. If the treatment was received in an outpatient clinic, it was considered an outpatient cost. All hospital discharges with a primary or secondary diagnosis of prostate cancer were included in this study.

Currently, there are conflicting recommendations regarding PSA testing among men without symptoms. The American Urological Association, Inc. and the American Cancer Society (ACS) propose annual PSA testing among asymptomatic men beginning at age 50. The US Preventive Services Task Force and the National Cancer Institute recommend against PSA testing among men with no symptoms.

It has been estimated that the ACS recommendations would cost an estimated $12.7 billion each year and would have profound morbidity consequences and uncertain benefits regarding mortality, said the researchers. That is, many men would be diagnosed with prostate cancer, but many of these men would not die of the disease. 

Thus, it is necessary to determine
who should be screened and when in order to design cost-effective screening protocols.  Studies such as this one identify the costs of the disease and are necessary to perform such analyses. 

Co-investigators on this study include: Dorothy P. Rice, Sc.D. (Hon.), professor emerita in the UCSF Institute for Health and Aging; Hai-Yen Sung, PhD, research specialist; in the UCSF Institute of Health and Aging;  Martha Michel, MPH, UCSF graduate student in bioinformatics; Wendy Breuer, RN, clinical nurse specialist in the UCSF Institute for Health and Aging; and Xiulan Zhang, PhD, former researcher specialist in the UCSF Institute for Health and Aging. This research was funded by state of California Department of Health Services, Cancer Research Program.