Table 2.
Calculated cost per day (CCPD) by first-line management strategy a
| Favorable risk |
Unfavorable risk |
||||||
|---|---|---|---|---|---|---|---|
| AS | SUR | RAD | p value | SUR | RAD | p value | |
| Total 24-mo period | |||||||
| Patients, n (%) | 791 (23.0) | 1175 (34.2) | 361 (10.5) | 700 (20.4) | 406 (11.8) | ||
| Healthcare encounters, median (IQR) | 8 (4, 15) | 8 (5, 14) | 18 (6, 46) | <0.001 | 10 (5, 26) | 43 (16, 55) | <0.001 |
| Unadjusted CCPD, $/d (IQR) | 3.06 (1.55, 6.88) | 6.52 (4.32, 9.05) | 13.16 (4.09, 32.73) | <0.001 | 7.72 (4.59, 15.67) | 24.10 (11.72, 51.15) | <0.001 |
| Adjusted CCPD, $/d (95% CI) | 2.97 (2.73, 3.23) | 5.67 (5.29, 6.08) | 9.34 (8.26, 10.58) | <0.001 | 7.17 (6.48, 7.94) | 16.34 (14.26, 18.72) | <0.001 |
| Initial treatment component of 24 mo period | |||||||
| Patients, n | 1073 | 314 | 582 | 368 | |||
| Healthcare encounters, median (IQR) | 6 (3, 7) | 8 (2, 38) | <0.001 | 5 (2, 7) | 34 (6, 46) | <0.001 | |
| Unadjusted CCPD, $/d (IQR) | 35.05 (20.37, 48.68) | 47.44 (25.31, 93.75) | <0.001 | 37.91 (18.65, 53.34) | 79.96 (41.63, 174.70) | <0.001 | |
| Adjusted CCPD, $/d (95% CI) | 27.68 (25.92, 29.57) | 34.69 (30.64, 39.28) | 0.002 | 27.30 (24.75, 30.11) | 61.32 (54.07, 69.54) | <0.001 | |
| Post-treatment surveillance component of 24-mo period | |||||||
| Patients, n | 788 | 291 | 515 | 347 | |||
| Healthcare encounters, median (IQR) | 3 (0, 7) | 4 (1, 10) | <0.001 | 5 (0, 17) | 6 (1, 14) | 0.17 | |
| Unadjusted CCPD, $/d (IQR) | 1.08 (0.49, 3.64) | 1.26 (0.56, 3.02) | 0.66 | 2.96 (0.69, 18.90) | 1.91 (0.83, 4.74) | 0.001 | |
| Adjusted CCPD, $/d (95% CI) | 1.45 (1.30, 1.61) | 1.30 (1.09, 1.55) | 0.30 | 3.24 (2.79, 3.75) | 2.06 (1.71, 2.47) | <0.001 | |
| Total 60-mo period | |||||||
| Patients, n | 365 (22.9) | 591 (37.1) | 160 (10.1) | 306 (19.2) | 169 (10.6) | ||
| Healthcare encounters, median (IQR) | 22 (12, 46) | 12 (6, 26) | 40 (12, 70) | <0.001 | 22 (7, 60) | 66 (44, 86) | <0.001 |
| Unadjusted CCPD, $/d (IQR) | 3.38 (1.51, 6.19) | 2.96 (1.89, 4.34) | 6.09 (1.55, 22.48) | <0.001 | 3.88 (2.07, 10.83) | 19.71 (7.86, 26.10) | <0.001 |
| Adjusted CCPD, $/d (95% CI) | 2.71 (2.39, 3.06) | 2.87 (2.60, 3.16) | 4.36 (3.62, 5.26) | <0.001 | 4.15 (3.57, 4.83) | 10.32 (8.38, 12.71) | <0.001 |
AS = active surveillance; CCPD = calculated cost per day; CI = confidence interval; IQR = interquartile range; RAD = radiation therapy; SUR = surgery.
Patients were diagnosed with prostate cancer during 2009–2018. Unfavorable defined as either stage ≥3 or Gleason grade group ≥3. CCPD values were obtained from Medicare Fee Schedule [28] and presented in 2017 USD/d [30]. Episodes of care (Fig. 2) include the total period over the first 24 mo or 60 mo from diagnosis (primary analysis), and for patients receiving definitive management with SUR or RAD, additional subdivisions of initial treatment and post-treatment component periods of the 24 mo since diagnosis (see Supplementary Table 4 for 60-mo equivalents). Unadjusted CCPD was assessed by the Kruskal-Wallis test by ranks. Adjusted CCPD accounts for age and comorbidity via analysis of covariance log-linear models.