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. 2000 Apr 4;162(7):987–992.

The economic burden of prostate cancer in Canada: forecasts from the Montreal Prostate Cancer Model

S A Grover 1, L Coupal 1, H Zowall 1, R Rajan 1, J Trachtenberg 1, M Elhilali 1, M Chetner 1, L Goldenberg 1
PMCID: PMC1232350  PMID: 10763396

Abstract

BACKGROUND: We developed an economic model of prostate cancer management from diagnosis until death. We have used the Montreal Prostate Cancer Model to estimate the total economic burden of the disease in a cohort of Canadian men. METHODS: Using this Markov state-transition simulation model, we estimated the probability of prostate cancer, annual prostate cancer progression rates and associated direct medical costs according to patient age, tumour stage and grade, and treatment modalities in a 1997 cohort of Canadian men. The estimated lifetime costs of prostate cancer included the costs of clinical staging, initial treatments and complications, follow-up cancer therapies, routine outpatient care, and palliative care following metastatic disease. RESULTS: The clinical burden of prostate cancer forecasted using the model was similar to the projections of the National Cancer Institute. In the 1997 cohort of 5.8 million Canadian men between 40 and 80 years old, prostate cancer would be diagnosed in an estimated 701,491 men (12.1%) over their lifetime. Direct medical costs would total $9.76 billion, or $3.89 billion when discounted 5% annually. INTERPRETATION: The Montreal Prostate Cancer Model indicates that the economic burden of prostate cancer to Canada's health care system will be substantial. Further analyses are needed to identify the most efficient means of treating this disease.

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Selected References

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  1. Albertsen P. C., Fryback D. G., Storer B. E., Kolon T. F., Fine J. Long-term survival among men with conservatively treated localized prostate cancer. JAMA. 1995 Aug 23;274(8):626–631. [PubMed] [Google Scholar]
  2. Aus G., Hugosson J., Norlén L. Need for hospital care and palliative treatment for prostate cancer treated with noncurative intent. J Urol. 1995 Aug;154(2 Pt 1):466–469. doi: 10.1097/00005392-199508000-00034. [DOI] [PubMed] [Google Scholar]
  3. Aus G., Pileblad E., Hugosson J. Impact of competing mortality on the cancer-related mortality in localized prostate cancer. Urology. 1995 Nov;46(5):672–675. doi: 10.1016/S0090-4295(99)80299-4. [DOI] [PubMed] [Google Scholar]
  4. Barry M. J., Fleming C., Coley C. M., Wasson J. H., Fahs M. C., Oesterling J. E. Should Medicare provide reimbursement for prostate-specific antigen testing for early detection of prostate cancer? Part I: Framing the debate. Urology. 1995 Jul;46(1):2–13. doi: 10.1016/s0090-4295(99)80151-4. [DOI] [PubMed] [Google Scholar]
  5. Barry M. J., Fleming C., Coley C. M., Wasson J. H., Fahs M. C., Oesterling J. E. Should Medicare provide reimbursement for prostate-specific antigen testing for early detection of prostate cancer? Part III: Management strategies and outcomes. Urology. 1995 Sep;46(3):277–289. doi: 10.1016/S0090-4295(99)80208-8. [DOI] [PubMed] [Google Scholar]
  6. Chamberlain J., Melia J., Moss S., Brown J. Report prepared for the Health Technology Assessment panel of the NHS Executive on the diagnosis, management, treatment and costs of prostate cancer in England and Wales. Br J Urol. 1997 May;79 (Suppl 3):1–32. doi: 10.1111/j.1464-410x.1997.tb16914.x. [DOI] [PubMed] [Google Scholar]
  7. Chodak G. W., Thisted R. A., Gerber G. S., Johansson J. E., Adolfsson J., Jones G. W., Chisholm G. D., Moskovitz B., Livne P. M., Warner J. Results of conservative management of clinically localized prostate cancer. N Engl J Med. 1994 Jan 27;330(4):242–248. doi: 10.1056/NEJM199401273300403. [DOI] [PubMed] [Google Scholar]
  8. Coley C. M., Barry M. J., Fleming C., Fahs M. C., Mulley A. G. Early detection of prostate cancer. Part II: Estimating the risks, benefits, and costs. American College of Physicians. Ann Intern Med. 1997 Mar 15;126(6):468–479. doi: 10.7326/0003-4819-126-6-199703150-00010. [DOI] [PubMed] [Google Scholar]
  9. Coley C. M., Barry M. J., Fleming C., Mulley A. G. Early detection of prostate cancer. Part I: Prior probability and effectiveness of tests. The American College of Physicians. Ann Intern Med. 1997 Mar 1;126(5):394–406. doi: 10.7326/0003-4819-126-5-199703010-00010. [DOI] [PubMed] [Google Scholar]
  10. Cowen M. E., Chartrand M., Weitzel W. F. A Markov model of the natural history of prostate cancer. J Clin Epidemiol. 1994 Jan;47(1):3–21. doi: 10.1016/0895-4356(94)90029-9. [DOI] [PubMed] [Google Scholar]
  11. Denis L. J., Carnelro de Moura J. L., Bono A., Sylvester R., Whelan P., Newling D., Depauw M. Goserelin acetate and flutamide versus bilateral orchiectomy: a phase III EORTC trial (30853). EORTC GU Group and EORTC Data Center. Urology. 1993 Aug;42(2):119–130. doi: 10.1016/0090-4295(93)90634-m. [DOI] [PubMed] [Google Scholar]
  12. Fleming C., Wasson J. H., Albertsen P. C., Barry M. J., Wennberg J. E. A decision analysis of alternative treatment strategies for clinically localized prostate cancer. Prostate Patient Outcomes Research Team. JAMA. 1993 May 26;269(20):2650–2658. [PubMed] [Google Scholar]
  13. Fowler F. J., Jr, Barry M. J., Lu-Yao G., Roman A., Wasson J., Wennberg J. E. Patient-reported complications and follow-up treatment after radical prostatectomy. The National Medicare Experience: 1988-1990 (updated June 1993). Urology. 1993 Dec;42(6):622–629. doi: 10.1016/0090-4295(93)90524-e. [DOI] [PubMed] [Google Scholar]
  14. Fowler F. J., Jr, Barry M. J., Lu-Yao G., Wasson J. H., Bin L. Outcomes of external-beam radiation therapy for prostate cancer: a study of Medicare beneficiaries in three surveillance, epidemiology, and end results areas. J Clin Oncol. 1996 Aug;14(8):2258–2265. doi: 10.1200/JCO.1996.14.8.2258. [DOI] [PubMed] [Google Scholar]
  15. Gerber G. S., Thisted R. A., Scardino P. T., Frohmuller H. G., Schroeder F. H., Paulson D. F., Middleton A. W., Jr, Rukstalis D. B., Smith J. A., Jr, Schellhammer P. F. Results of radical prostatectomy in men with clinically localized prostate cancer. JAMA. 1996 Aug 28;276(8):615–619. [PubMed] [Google Scholar]
  16. Grover S. A., Coupal L., Zowall H., Rajan R., Trachtenberg J., Elhilali M., Chetner M., Goldenberg L. The clinical burden of prostate cancer in Canada: forecasts from the Montreal Prostate Cancer Model. CMAJ. 2000 Apr 4;162(7):977–983. [PMC free article] [PubMed] [Google Scholar]
  17. Grover S. A., Zowall H., Coupal L., Krahn M. D. Prostate cancer: 12. The economic burden. CMAJ. 1999 Mar 9;160(5):685–690. [PMC free article] [PubMed] [Google Scholar]
  18. Hugosson J., Aus G. Natural course of localized prostate cancer. a personal view with a review of published papers. Anticancer Res. 1997 May-Jun;17(3A):1441–1448. [PubMed] [Google Scholar]
  19. Hugosson J., Aus G., Norlén L. Surveillance is not a viable and appropriate treatment option in the management of localized prostate cancer. Urol Clin North Am. 1996 Nov;23(4):557–573. doi: 10.1016/s0094-0143(05)70336-0. [DOI] [PubMed] [Google Scholar]
  20. Johansson J. E., Holmberg L., Johansson S., Bergström R., Adami H. O. Fifteen-year survival in prostate cancer. A prospective, population-based study in Sweden. JAMA. 1997 Feb 12;277(6):467–471. [PubMed] [Google Scholar]
  21. Jones G. W., Mettlin C., Murphy G. P., Guinan P., Herr H. W., Hussey D. H., Chmiel J. S., Fremgen A. M., Clive R. E., Zuber-Ocwieja K. E. Patterns of care for carcinoma of the prostate gland: results of a national survey of 1984 and 1990. J Am Coll Surg. 1995 May;180(5):545–554. [PubMed] [Google Scholar]
  22. Krahn M. D., Mahoney J. E., Eckman M. H., Trachtenberg J., Pauker S. G., Detsky A. S. Screening for prostate cancer. A decision analytic view. JAMA. 1994 Sep 14;272(10):773–780. [PubMed] [Google Scholar]
  23. Lawton C. A., Won M., Pilepich M. V., Asbell S. O., Shipley W. U., Hanks G. E., Cox J. D., Perez C. A., Sause W. T., Doggett S. R. Long-term treatment sequelae following external beam irradiation for adenocarcinoma of the prostate: analysis of RTOG studies 7506 and 7706. Int J Radiat Oncol Biol Phys. 1991 Sep;21(4):935–939. doi: 10.1016/0360-3016(91)90732-j. [DOI] [PubMed] [Google Scholar]
  24. Lee R. J., Sause W. T. Surgically staged patients with prostatic carcinoma treated with definitive radiotherapy: fifteen-year results. Urology. 1994 May;43(5):640–644. doi: 10.1016/0090-4295(94)90178-3. [DOI] [PubMed] [Google Scholar]
  25. Lu-Yao G. L., McLerran D., Wasson J., Wennberg J. E. An assessment of radical prostatectomy. Time trends, geographic variation, and outcomes. The Prostate Patient Outcomes Research Team. JAMA. 1993 May 26;269(20):2633–2636. doi: 10.1001/jama.269.20.2633. [DOI] [PubMed] [Google Scholar]
  26. Lu-Yao G. L., Potosky A. L., Albertsen P. C., Wasson J. H., Barry M. J., Wennberg J. E. Follow-up prostate cancer treatments after radical prostatectomy: a population-based study. J Natl Cancer Inst. 1996 Feb 21;88(3-4):166–173. doi: 10.1093/jnci/88.3-4.166. [DOI] [PubMed] [Google Scholar]
  27. Lu-Yao G. L., Yao S. L. Population-based study of long-term survival in patients with clinically localised prostate cancer. Lancet. 1997 Mar 29;349(9056):906–910. doi: 10.1016/S0140-6736(96)09380-4. [DOI] [PubMed] [Google Scholar]
  28. Lubke W. L., Optenberg S. A., Thompson I. M. Analysis of the first-year cost of a prostate cancer screening and treatment program in the United States. J Natl Cancer Inst. 1994 Dec 7;86(23):1790–1792. doi: 10.1093/jnci/86.23.1790. [DOI] [PubMed] [Google Scholar]
  29. McNaughton Collins M., Ransohoff D. F., Barry M. J. Early detection of prostate cancer. Serendipity strikes again. JAMA. 1997 Nov 12;278(18):1516–1519. doi: 10.1001/jama.278.18.1516. [DOI] [PubMed] [Google Scholar]
  30. Mellinger G. T., Gleason D., Bailar J., 3rd The histology and prognosis of prostatic cancer. J Urol. 1967 Feb;97(2):331–337. doi: 10.1016/S0022-5347(17)63039-8. [DOI] [PubMed] [Google Scholar]
  31. Mettlin C. J., Murphy G. P., Ho R., Menck H. R. The National Cancer Data Base report on longitudinal observations on prostate cancer. Cancer. 1996 May 15;77(10):2162–2166. doi: 10.1002/(SICI)1097-0142(19960515)77:10<2162::AID-CNCR30>3.0.CO;2-R. [DOI] [PubMed] [Google Scholar]
  32. Mettlin C. J., Murphy G. P., McGinnis L. S., Menck H. R. The National Cancer Data Base report on prostate cancer. American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer. 1995 Sep 15;76(6):1104–1112. doi: 10.1002/1097-0142(19950915)76:6<1104::aid-cncr2820760627>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]
  33. Mettlin C. J., Murphy G. The National Cancer Data Base report on prostate cancer. Cancer. 1994 Sep 1;74(5):1640–1648. doi: 10.1002/1097-0142(19940901)74:5<1640::aid-cncr2820740525>3.0.co;2-3. [DOI] [PubMed] [Google Scholar]
  34. Mettlin C., Jones G. W., Murphy G. P. Trends in prostate cancer care in the United States, 1974-1990: observations from the patient care evaluation studies of the American College of Surgeons Commission on Cancer. CA Cancer J Clin. 1993 Mar-Apr;43(2):83–91. doi: 10.3322/canjclin.43.2.83. [DOI] [PubMed] [Google Scholar]
  35. Miles B. J., Kattan M. W. Computer modeling of prostate cancer treatment. A paradigm for oncologic management? Surg Oncol Clin N Am. 1995 Apr;4(2):361–372. [PubMed] [Google Scholar]
  36. Moore M. J., Osoba D., Murphy K., Tannock I. F., Armitage A., Findlay B., Coppin C., Neville A., Venner P., Wilson J. Use of palliative end points to evaluate the effects of mitoxantrone and low-dose prednisone in patients with hormonally resistant prostate cancer. J Clin Oncol. 1994 Apr;12(4):689–694. doi: 10.1200/JCO.1994.12.4.689. [DOI] [PubMed] [Google Scholar]
  37. Otnes B., Harvei S., Fosså S. D. The burden of prostate cancer from diagnosis until death. Br J Urol. 1995 Nov;76(5):587–594. doi: 10.1111/j.1464-410x.1995.tb07783.x. [DOI] [PubMed] [Google Scholar]
  38. Perez C. A., Pilepich M. V., Garcia D., Simpson J. R., Zivnuska F., Hederman M. A. Definitive radiation therapy in carcinoma of the prostate localized to the pelvis: experience at the Mallinckrodt Institute of Radiology. NCI Monogr. 1988;(7):85–94. [PubMed] [Google Scholar]
  39. To T., Iscoe N., Klotz L., Naylor C. D. Orchidectomy and hormonal therapy of prostate cancer. Can J Urol. 1995 Jan;2(1):109–115. [PubMed] [Google Scholar]
  40. Wasson J. H., Cushman C. C., Bruskewitz R. C., Littenberg B., Mulley A. G., Jr, Wennberg J. E. A structured literature review of treatment for localized prostate cancer. Prostate Disease Patient Outcome Research Team. Arch Fam Med. 1993 May;2(5):487–493. doi: 10.1001/archfami.2.5.487. [DOI] [PubMed] [Google Scholar]
  41. Weinstein M. C., Siegel J. E., Gold M. R., Kamlet M. S., Russell L. B. Recommendations of the Panel on Cost-effectiveness in Health and Medicine. JAMA. 1996 Oct 16;276(15):1253–1258. [PubMed] [Google Scholar]
  42. Wodinsky H. B., Jenkin R. D. The cost of radiation treatment at an Ontario regional cancer centre. CMAJ. 1987 Nov 15;137(10):906–909. [PMC free article] [PubMed] [Google Scholar]
  43. Zagars G. K., von Eschenbach A. C., Johnson D. E., Oswald M. J. Stage C adenocarcinoma of the prostate. An analysis of 551 patients treated with external beam radiation. Cancer. 1987 Oct 1;60(7):1489–1499. doi: 10.1002/1097-0142(19871001)60:7<1489::aid-cncr2820600715>3.0.co;2-9. [DOI] [PubMed] [Google Scholar]

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