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Urology Practice Management - June 2015, Vol 4, No 3 - Prostate Cancer
Alice Goodman

Significant cost-savings in treating patients with prostate cancer could be achieved in the US healthcare system with the use of the cell-cycle progression (CCP) gene-expression assay called Prolaris (from Myriad Genetics Laboratories), according to a poster from E. David Crawford, MD, Professor of Surgery and Radiation Oncology, University of Colorado, Aurora, and colleagues, presented at the 2015 Genitourinary Cancers Symposium.

The use of appropriate treatment in patients with localized prostate cancer based on disease aggressiveness remains a challenge; lack of disease stratification by high- and low-risk disease leads to overtreatment of patients with low-risk prostate cancer and undertreatment of patients with high-risk disease.

Having a strategy that could better differentiate between low- and high-risk localized prostate cancer could improve the use of appropriate treatment, thereby saving costs of eliminating overtreatment.

Prolaris Testing Reduces Costs

In a US commercial health plan with 10 million members, the use of Prolaris could reduce the cost per patient tested by $2850 over 10 years, translating to a cost-savings of $16 million, according to an evidence-based economic model with a hypothetical group of patients with localized prostate cancer.

Based on this model, 67% of the savings would occur in the first year of instituting Prolaris testing. A net reduction of $2850 in cost per patient accrued over 10 years after the initial cost for the assay (approximately $3400).

The model applied assumptions about management and progression based on published clinical data and interviews with board-certified physicians. The study compared reference scenarios and test scenarios.

“Total cost of care was calculated for a reference scenario [current clinical practice] and a test scenario where patient management was altered based on CCP test results,” noted Dr Crawford and colleagues.

Comparisons between the scenarios were made for the following patient management groups—active surveillance, radical prostatectomy only, radiation therapy only, androgen-deprivation therapy only, rad­ical prostatectomy and radiation therapy, and radiation therapy and androgen-deprivation therapy.

The costs of the test scenario never exceeded the costs in the reference scenarios.

The savings were attributable to 2 key factors, with the majority of the savings attributed to the increased use of active surveillance for low- and intermediate-risk patients, as defined by the American Urological Association.

In these 2 risk-based groups, 15% and 5% of patients, respectively, would have received active surveillance according to current clinical practice. When the test scenario clinical treatment paradigm was applied, these percentages increased to 69% and 27% of active surveillance in these respective groups.

Additional savings came from reduced disease progression rates in high-risk patients with more aggressive disease who moved on to multimodality therapy.

The Prolaris test was added to the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology in October 2014, calling for the use of the test in all men with localized prostate cancer, regardless of the risk category.

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Last modified: June 11, 2015
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