Though major medical associations advise against prostate cancer screening in men over the age of 70, treatment in elderly populations costs Medicare more than $400 million a year, according to research published online Sept. 13 in JAMA Oncology. These costs include claims for CT, MRI and bone scans for diagnosis and follow-up imaging.
"The tough discussions that happen in health economics are often cases where care is beneficial, but costly. That's a hard trade-off, but this one is actually easier than that," said UNC Lineberger's Justin Trogdon, PhD, associate professor of health policy management in the UNC Gillings School of Global Public Health, in a prepared statement. "This is a scenario where care is probably not beneficial and also costly, and we are putting a dollar figure on just how costly this is."
The researchers conducted a retrospective study on nearly 50,000 men over the age of 70 who were diagnosed with prostate cancer between 2004 and 2007. The three-year total in Medicare costs was $1.2 billion. The average cost per patient was $14,453 with treatment, including imaging, accounting for 73 percent of that total.
The authors suggest active surveillance, a tactic becoming more popular among low-risk patients, could save Medicare $320 million. Limiting such screening in low-risk individuals over the age of 75 would save $132 million.
“With rising healthcare costs, it is imperative for research to identify areas of lower value health care services,” Trogdon et al. wrote. “Cessation of aggressive treatment of low-risk prostate cancer among elderly patients represents an opportunity to benefit the patient—by preventing harm from treatments that are unlikely to lead to improved survival—while also providing large annual cost savings to Medicare.”
Both the American Academy of Family Physicians and U.S. Preventive Services Task Force (USPSTF) dissuade men over 70 to undergo screening. Because the cancer is often slow-growing, older individuals are likely to die of other causes, diminishing the benefits of screenings. According to the USPSTF, men between 55 and 69 should ”discuss the potential benefits and harms of screening with their clinician and to incorporate their values and preferences in the decision.”