Cancer Treatment: Cost Vs. Effectiveness

Prostate cancer radiotherapies differ mostly in cost according to new analysis

(RxWiki News) As technology advances, physicians and patients tend to want to use the latest treatment options. These new therapies typically come with a higher price tag. But are they better?

A recent study suggests that newer prostate cancer radiation therapy technology is more costly, but not more effective.

This study compared the outcomes of patients who received intensity-modulated radiotherapy (IMRT) and the older conformal radiotherapy (CRT).

Complications resulting in new conditions (co-morbidities) were similar for both therapies.

"Research the cost of your cancer treatments."

Gregg H. Goldin, MD, of the University of North Carolina at Chapel Hill, directed this study, which relied on data from the Surveillance, Epidemiology and End Results (SEER)-Medicare-linked database. As such, this was an observational study.

Frank Vicini, MD, FACR, radiation oncologist at 21st Century Oncology in Royal Oak, MI, told dailyRx News these types of studies are flawed. “Comparative effectiveness studies using Medicare data are notorious for their inherent deficiencies and weaknesses and can be dangerous when used to refute or contradict higher level evidence (data) that has been generated using state-of-the-art scientific methods and statistical tools,” Dr. Vicini said.

CRT uses 3D computer images to conform the radiation beam to a man’s body and internal organs. The goal is to direct the beam only at the prostate while keeping nearby organs (bladder and rectum) unharmed.

IMRT is a more advanced and precise form of CRT that’s been demonstrated to be less toxic and more accurate in delivering radiation to the prostate.

For this study, the researchers looked at the outcomes of 457 prostate cancer patients who had IMRT and 557 men who underwent CRT between 2002 and 2007.

The use of IMRT rose 82 percent between 2000 and 2009, the researchers noted.

Study results showed no significant difference in the incidence of radiotherapy-related comorbidities, including gastrointestinal problems, urinary or bowel control issues or sexual dysfunction.

"We found no significant difference in the rates of morbidity in patients who received IMRT vs CRT or in the rate of receiving subsequent additional cancer therapies. Our results provide new and important information to patients, physicians and other decision makers on the currently available evidence regarding the outcomes of different post-prostatectomy radiation techniques,” the authors wrote.

A 2012 article published in the Journal of Oncology Practice did find that the mean cost of IMRT following prostate cancer surgery was $35,431, while stereotactic body radiation therapy (a type of CRT) cost $22,152.

Dr. Vicini said, “There is no reason to believe that something with a proven track record to have less toxicity (IMRT) in a similar setting (definitive prostate cancer treatment) would not work as well after prostatectomy. The results of the report make little sense and point out the inherent weakness and potential dangers of such analyses.”

This study was published May 20 in JAMA-Internal Medicine.

The study was funded through a contract from the Agency for Healthcare Research and Quality, US Department of Health and Human Services, as part of the DEcIDE program. One of the authors, Dr. Sturmer, disclosed that he receives research funding from various governmental agencies and several pharmaceutical companies, including GlaxoSmithKline, Merck and Sanofi.

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Review Date: 
May 20, 2013