Prostate Cancer: Cost Savings from Active Surveillance Interview with:
Alice Dragomir, MSc, PhD
Assistant Professor,
Urology/Surgery, McGill University
Scientist, RI-MUHC What are the main findings of the study?

Authors’ response: Our study demonstrates that for eligible patients, active surveillance could offer not only the known clinical advantages from the patient’s perspective, but also economic benefits from the health care system’s perspective. At the national level, the cost savings of an annual cohort of incident prostate cancers managed with active surveillance over a first year and 5 years of follow-up could be substantial. These are estimated at $96 million. Were any of the findings unexpected?

Authors’ response: The difference between the cost per patient on active surveillance and cost per patient receiving immediate treatment is impressive. Over the first year and 5 years of follow-up these costs are estimated at: $6200 for active surveillance and $13 735 for immediate treatment, corresponding to a relative reduction of 54.9% for active surveillance. What should clinicians and patients take away from your report?

Authors’ response: When no additional clinical benefits are expected with an early initiation of an active treatment, clinicians can be reassured that there is no economic reason for it. Our results confirm that delayed treatment is associated with additional costs in patients requiring treatment after active surveillance, but this cost is minimal. What recommendations do you have for future research as a result of this study?

Authors’ response: Our study was based on a modeling approach, with initial and follow-up costs of treatments and active surveillance derived from hospital protocols. Future research on observational studies could be performed to account for actual healthcare resources used, as well as for adverse events and complications related to treatments.
Active surveillance for low-risk prostate cancer
compared with immediate treatment: a Canadian cost comparison
Alice Dragomir PhD, Fabio L. Cury MD, Armen G. Aprikian MD
CMAJ Open April 24, 2014