TY - JOUR
T1 - Long-Term Medical Resource Consumption of Radical Prostatectomy vs. Intensity-Modulated Radiotherapy for Old Patients With Prostate Cancer
T2 - A Nationwide Population-Based Cohort Study
AU - Wu, Szu Yuan
AU - Effendi, Fransisca Fortunata
AU - Peng, Jhao Yang
AU - Huang, Chung Chien
N1 - Funding Information:
This work was supported by Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, supports S-YW work (Funding Numbers: 10908, 10909, 11001, 11002, 11003, 11006, and 11013).
Publisher Copyright:
Copyright © 2022 Wu, Effendi, Peng and Huang.
PY - 2022/5
Y1 - 2022/5
N2 - Purpose: Few studies have compared the long-term medical resource consumption between radical prostatectomy (RP) and intensity-modulated radiation therapy (IMRT) among old (≥80 years) patients with localized prostate cancer (LPC), particularly in those at high risk of prostate adenocarcinoma. Patients and Methods: The propensity score matching was conducted to investigate the medical expenditure of two therapeutic modalities (RP and IMRT) in elderly patients with high-risk LPC (HR-LPC). The generalized linear mixed and logistic regression models were employed to evaluate the number of postdischarge visits and medical reimbursement for urinary diseases or complications and the number of hospitalizations for treatment-related complications over 5 years after treatment, respectively. Results: Significant differences were observed in the median or mean urology clinic visit numbers across the two therapeutic modalities from the first until fifth year post treatment (p < 0.0001). After adjustment for covariates, the mean difference [95% confidence interval (CI)] of urology clinic visit numbers between RP and IMRT was 13.07 (10.45–15.49, P < 0.0001), 7.47 (8.01–14.92, P < 0.0001), 8.24 (4.59–9.90, P < 0.0001), 6.63 (3.55–11.70, P < 0.0001), and 5.02 (1.12–8.73, P < 0.0001) for the first, second, third, fourth, and fifth years, respectively. In the logistic regression multivariate model with adjustment for covariates [therapy type, age, diagnosis year, income, hospital area, hospital level (academic or nonacademic), clinical and pathological T-stage, grade (Gleason score), pretreatment PSA level (ng/ml), and D'Amico risk classification], the adjusted odds ratio (95% CI) of IMRT was 2.10 (1.37–2.56, P = 0.0013), 1.55 (1.08–2.21, P = 0.0151), 1.35 (1.08–2.21, P = 0.0084), 1.24 (1.07–2.21, P = 0.0071), and 1.09 (1.02–1.81, P = 0.0379) for the first, second, third, fourth, and fifth years, respectively, compared with those of RP. The mean difference (95% CI) of total medical claims amounts of RP and IMRT between the RP and IMRT + ADT groups was 2,69,823 New Taiwan Dollars (NTD) (247,676–291,970, P < 0.0001), 40,803 NTD (17,379–54,228, P < 0.0001), 36,202 NTD (24,375–68,029, P < 0.0001), 26,708 NTD (11,179–54,595, P = 0.0321), and 12,173 NTD (17,140–41,487, P = 0.0187) for the first, second, third, fourth, and fifth years, respectively. Conclusion: The long-term medical resource consumption was higher in old men with HR-LPC undergoing IMRT than in those undergoing RP.
AB - Purpose: Few studies have compared the long-term medical resource consumption between radical prostatectomy (RP) and intensity-modulated radiation therapy (IMRT) among old (≥80 years) patients with localized prostate cancer (LPC), particularly in those at high risk of prostate adenocarcinoma. Patients and Methods: The propensity score matching was conducted to investigate the medical expenditure of two therapeutic modalities (RP and IMRT) in elderly patients with high-risk LPC (HR-LPC). The generalized linear mixed and logistic regression models were employed to evaluate the number of postdischarge visits and medical reimbursement for urinary diseases or complications and the number of hospitalizations for treatment-related complications over 5 years after treatment, respectively. Results: Significant differences were observed in the median or mean urology clinic visit numbers across the two therapeutic modalities from the first until fifth year post treatment (p < 0.0001). After adjustment for covariates, the mean difference [95% confidence interval (CI)] of urology clinic visit numbers between RP and IMRT was 13.07 (10.45–15.49, P < 0.0001), 7.47 (8.01–14.92, P < 0.0001), 8.24 (4.59–9.90, P < 0.0001), 6.63 (3.55–11.70, P < 0.0001), and 5.02 (1.12–8.73, P < 0.0001) for the first, second, third, fourth, and fifth years, respectively. In the logistic regression multivariate model with adjustment for covariates [therapy type, age, diagnosis year, income, hospital area, hospital level (academic or nonacademic), clinical and pathological T-stage, grade (Gleason score), pretreatment PSA level (ng/ml), and D'Amico risk classification], the adjusted odds ratio (95% CI) of IMRT was 2.10 (1.37–2.56, P = 0.0013), 1.55 (1.08–2.21, P = 0.0151), 1.35 (1.08–2.21, P = 0.0084), 1.24 (1.07–2.21, P = 0.0071), and 1.09 (1.02–1.81, P = 0.0379) for the first, second, third, fourth, and fifth years, respectively, compared with those of RP. The mean difference (95% CI) of total medical claims amounts of RP and IMRT between the RP and IMRT + ADT groups was 2,69,823 New Taiwan Dollars (NTD) (247,676–291,970, P < 0.0001), 40,803 NTD (17,379–54,228, P < 0.0001), 36,202 NTD (24,375–68,029, P < 0.0001), 26,708 NTD (11,179–54,595, P = 0.0321), and 12,173 NTD (17,140–41,487, P = 0.0187) for the first, second, third, fourth, and fifth years, respectively. Conclusion: The long-term medical resource consumption was higher in old men with HR-LPC undergoing IMRT than in those undergoing RP.
KW - intensity-modulated radiation therapy
KW - localized prostate cancer
KW - medical resource consumption
KW - old-age
KW - radical prostatectomy
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U2 - 10.3389/fmed.2022.843709
DO - 10.3389/fmed.2022.843709
M3 - Article
AN - SCOPUS:85130495411
SN - 2296-858X
VL - 9
JO - Frontiers in Medicine
JF - Frontiers in Medicine
M1 - 843709
ER -