Abstract
Purpose
Methods and materials
Results
Conclusions
Introduction
- Centers for Medicare and Medicaid Services
Methods and materials
Study design and data collection
Decision analytic model

Base case probability inputs
Base case cost inputs
2014 U.S. payment rates
- Centers for Medicare and Medicaid Services
- Centers for Medicare and Medicaid Services
- Center for Medicare and Medicaid Services
- Centers for Medicare and Medicaid Services
- Centers for Medicare and Medicaid Services
Cost estimate verification using patient-level institutional costs
- U.S. Bureau of Labor Statistics
Data analysis
Sensitivity analysis
Results
Characteristic | CIMRT (75.6 Gy in 1.8 Gy fxns) 8.4 weeks n = 101 | HIMRT(72 Gy in 2.4 Gy fxns) 6 weeks n = 102 | P-value |
---|---|---|---|
Median age (range), y | 67 (48-84) | 69 (41-83) | .15 |
Tumor stage | .29 | ||
T1 | 76 (75%) | 70 (69%) | |
T2 | 25 (25%) | 32 (31%) | |
PSA | .35 | ||
<10 | 88 (87%) | 93 (91%) | |
10-20 | 13 (13%) | 9 (9%) | |
Gleason score | .81 | ||
6 | 37 (37%) | 33 (32%) | |
7 | 63 (62%) | 68 (67%) | |
8 | 1 (1%) | 1 (1%) | |
Risk group | .98 | ||
Low | 29 (29%) | 28 (27%) | |
Intermediate | 71 (70%) | 73 (72%) | |
High | 1 (1%) | 1 (1%) | |
Androgen deprivation therapy | .77 | ||
Yes (<4 mo) | 23 (23%) | 25 (25%) | |
No | 78 (77%) | 77 (75%) | |
Median follow-up (range), y | 5.6 (0.8-11.4) | 6.3 (0.9-11.2) | .67 |
Late genitourinary toxicity, grade | |||
0 | 71 (70%) | 77 (75%) | |
1 | 15 (15%) | 10 (10%) | |
2 | 14 (14%) | 15 (15%) | |
3 | 1 (1%) | 0 (0%) | .52 |
Late gastrointestinal toxicity, grade | |||
0 | 79 (78%) | 64 (63%) | |
1 | 17 (17%) | 27 (26%) | |
2 | 4 (4%) | 9 (9%) | |
3 | 1 (1%) | 2 (2%) | .11 |
5-Year PSA failure | 6% | 5.5% | .30 |
Treatment | 2014 value | Reference |
---|---|---|
Radiation | ||
Conventional | 29,367.16 | CMS |
Hypofractionated | 21,904.68 | CMS |
Procedures | ||
Colonoscopy, diagnostic | 976.26 | CMS |
Colonoscopy, with control of bleeding | 1090.9 | CMS |
Flexible sigmoidoscopy, diagnostic | 543.52 | CMS |
Flexible sigmoidoscopy, for control of bleed | 963.96 | CMS |
Anesthesia for lower endoscopy | 248.05 | CMS |
Catheterization urinary | 136.88 | CMS |
Catheterization, with dilatation | 192.77 | CMS |
Catheterization, with indwelling Foley catheter | 667.89 | CMS, AWP |
Catheterization, with bladder irrigation | 341.59 | CMS |
Cystourethroscopy | 761.32 | CMS |
Cystourethroscopy, with irrigation and clot removal | 1319.93 | CMS |
Cystourethroscopy, requiring general anesthesia | 941.34 | CMS |
Fluoro-urodynamic study | 1903.95 | CMS |
Transurethral resection of the prostate | 4885.21 | CMS |
Direct visual internal urethrotomy and mitomycin-C injection | 5277.71 | CMS |
Imaging and work-up | ||
CT pelvis, with contrast | 367.94 | CMS |
CT abdomen, with/without contrast | 422.98 | CMS |
Intravenous pyelogram | 307.76 | CMS |
Post void residual ultrasound | 72.43 | CMS |
Renal ultrasound | 172.18 | CMS |
Transabdominal ultrasound | CMS | |
Urine analysis and culture | 27.08 | CMS |
Urine cytology | 42.77 | CMS |
Clinic visits | ||
Outpatient new visit, level 3 | 169.55 | CMS |
Outpatient established visit, level 3 | 144.11 | CMS |
Emergency room visit, level 4 | 415.15 | CMS |
Medications, dose | ||
Hydrocortisone acetate (Anusol HC, Proctocort), 25 mg | 5.92 | AWP |
Pramoxine hydrochloride foam (Proctofoam HC), 15 g | 3.50 | AWP |
Psyllium (Metamucil), 3.4 g | 0.01 | AWP |
Docusate sodium (Colace), 100 mg | 0.01 | AWP |
Magnesium hydroxide (Milk of Magnesia), 30 mL | 0.00 | AWP |
Loperamide, 2 mg | 0.15 | AWP |
Diphenoxylate-atropine (Lomotil), 0.025-2.5 mg | 1.85 | AWP |
Tamsulosin (Flomax), 0.4 mg | 0.20 | AWP |
Alfuzosin (Uroxatral), 10 mg | 0.47 | AWP |
Terazosin, 10 mg | 1.60 | AWP |
Terazosin, 2 mg | 1.45 | AWP |
Oxybutynin (Ditropan), 10 mg | 6.32 | AWP |
Tolterodine tartrate (Detrol), 1 mg | 3.31 | AWP |
Tolterodine tartrate (Detrol LA), 4 mg | 9.83 | AWP |
Solifenacin (VESIcare), 5 mg | 8.85 | AWP |
Dutasteride (Avodart), 0.5 mg | 4.07 | AWP |
Finasteride (Proscar), 5 mg | 3.11 | AWP |
Ciprofloxacin hydrochloride, 500 mg | 0.21 | AWP |
Levofloxacin (Levaquin), 500 mg | 15.60 | AWP |
Doxycycline, 100 mg | 1.94 | AWP |
Trimethoprim/sulfamethoxazole (Bactrim DS), 800-160 mg | 3.12 | AWP |
Ibuprofen, 200 mg | 3.12 | AWP |
Calcium glycerophosphate (Prelief), 1 tablet | 0.02 | AWP |
Base case cost-minimization analysis
Parameter | Estimated cost per patient (2014 $US) | CIMRT-HIMRT cost difference (range) | Relative cost of HIMRT | |
---|---|---|---|---|
CIMRT | HIMRT | |||
2014 National Reimbursement (Base Case) | 30,241 | 22,957 | 7284 | .76 |
Parameter 1 | 29,905-35,244 | 22,957 | 6948-12,287 | .77-.65 |
Parameter 2 | 31,981-30,149 | 22,957 | 9024-7192 | .72-.76 |
Parameter 3 | 29,974-31,646 | 22,957 | 7017-8689 | .77-.73 |
Parameter 4 | 28,642-30,241 | 22,957 | 5685-7284 | .80-.76 |
Parameter 5 | 28,642-30,241 | 22,957 | 5685-7284 | .80-.76 |
Model, beta distribution | 30,232 | 23,001 | 7231 | .76 |
Model, gamma distribution | 30,251 | 22,979 | 7272 | .76 |
Model, gamma and beta distribution | 30,233 | 22,965 | 7268 | .76 |
Institutional cost, n = 203 | 15,856 | .61 | ||
Institutional cost, excluding men with treatment of other cancers, n = 189 | 5840 | .80 | ||
Model using institutional cost, gamma and beta distribution | 5826 | .80 |
Sensitivity analysis

Alternative case scenario
Radiation and late toxicity management cost components

Discussion
- Zemplenyi A.T.
- Kalo Z.
- Kovacs G.
- et al.
Conclusions
Acknowledgments
Supplementary data
- Appendix S1
Supplementary Tables 1-4.
- Appendix S1
Supplementary methods.
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Article Info
Publication History
Footnotes
Meeting information: This manuscript was presented at the 97th American Radium Society Meeting, May 2-5, 2015 in Kauai, HI. This manuscript was submitted as the dissertation for K.R.V.'s graduate work, and its abstract is available at the University of Texas, School Of Public Health in the Proquest Dissertation Database.
Sources of support: The open access fee for this article was paid for by a 2017 grant from the Radiation Oncology Institute (ROI), and a $5,000 grant to continue research on the value of RT was awarded.
Conflicts of interest: L.S.L. is employed by and has stock in a for-profit healthcare company. S.J.F. has a consulting relationship with, honoraria from, ownership interest in, and a patent with for-profit healthcare companies.
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