Men who get prostate cancer surgery at hospitals that do a lot of these procedures may have better results, and those better outcomes might help offset the added cost of care at specialized facilities, a U.S. study suggests.
Plenty of evidence for prostate cancer and a host of other medical conditions links the best outcomes to the most experienced surgeons. The current study adds a fresh analysis of the economic benefits of sending patients to facilities that perform the procedure often, even if they might be far from home or have higher fees than community hospitals.
"The data reinforces the dictum that getting it right the first time is always the most cost effective approach," senior study author Dr. Sarmad Sadeghi of the Norris Comprehensive Cancer Center at the University of Southern California in Los Angeles said by email.
"Our analysis shows that societal costs of long-term care for prostate cancer will be reduced as a result of fewer treatment failures," Sadeghi added.
Researchers focused on radical prostatectomies, procedures that excise tumors by removing the prostate gland as well as surrounding tissue.
Most U.S. surgeons who do these operations handle less than 10 cases a year, but they account for an estimated 40 percent of prostatectomies, Sadeghi and colleges report in the journal Prostate Cancer and Prostatic Diseases.
The research team used data on typical outcomes to estimate how costs might change if more prostatectomies were performed by what they call "high-volume" surgeons, who did at least 250 of the procedures each year.
When patients saw the high-volume surgeons, they were less likely to have cancer recur, to require salvage radiation therapy after initial treatment or to develop tumors that spread beyond the prostate, the analysis found.
To calculate the potential cost savings associated with more experience, researchers estimated what would happen in four different scenarios based on the proportion of operations done by high-volume surgeons, ranging from 50 to 80 percent of procedures.
Compared with when high-volume surgeons did only half the surgeries, when they did 80 percent of the cases the estimated costs savings per operation were $177, $357 and $559 at 5, 10 and 20 years, respectively.
These savings would offset the estimated referral costs of up to $1,833 per prostatectomy for sending patients to the high-volume centers, the researchers calculated.
Limitations of the study include the fact that these cost savings are based on a mathematical model built on several different previous studies done at different times. The results are also based on the current typical progression of prostate cancer, which might change with advances in treatment.
It's also possible that the calculations underestimated the potential cost savings because the researchers focused on cancer recurrence but didn't look at other expensive outlays related to managing complications such as impotence and incontinence that can be more common with less experienced surgeons, Dr. Quoc-Dien Trinh, a urologist at Brigham and Women's Hospital in Boston who wasn't involved in the study, said by email.
Patients should also be careful not to focus on the surgeon's experience level until after they determine whether they actually need surgery, because many men with slow-growing tumors don't necessarily need prostatectomies, said Dr. Daniel Barocas, a researcher in surgical quality and outcomes at Vanderbilt University Medical Center in Nashville, Tennessee, who wasn't involved in the study.
"If you skip ahead and go straight to a high-volume surgeon or a high-volume radiation therapist, you may not get the full benefit of counseling regarding whether to treat or what treatment is best," Barocas said by email. "For a patient who has decided on a prostatectomy, however, both the center and the surgeon are important."