Prostate CancerDiffusion and Economic Consequences of Health Technologies in Prostate Cancer Care in Sweden, 1991–2002
Introduction
Prostate cancer is the most common malignancy in Sweden and constitutes over 30 percent of all male cancers [1]. In 1991 5,294 men (124/100,000) were diagnosed with prostate cancer in Sweden and in 2002 there were 9,035 cases (204/100,000) [1]. Prostate cancer is also the leading cause of death among men with 2,164 deaths recorded in 1991 (51/100,000) and 2,460 in 2001 (56/100,000) [2].
In the past two decades, management of the disease has undergone considerable change. With the introduction of PSA-tests, early diagnosis of the disease became possible. Treatment of early disease using surgical (radical prostatectomy) and radiological techniques (external radiotherapy and brachytherapy) was improved and utilized rather than watchful waiting, which was the predominate strategy for managing early prostate cancer in Sweden up until that time. For advanced disease, new forms of treatment such as depot-injection of GnRH-analogues and oral non-steroidal antiandrogens were introduced, and they nearly replaced surgical castration, which had been the standard treatment for six decades. The changes in disease management have incurred considerable cost increases [3] despite poor evidence regarding important health benefits [4], [5], [6], [7], [8]. However, a recent study showed that radical prostatectomy reduces mortality compared to watchful waiting in early prostate cancer [9].
To ensure an optimal use of resources for health care it is essential to be able to adequately guide and control the rate and extent of diffusion of new health technologies. Without regulating activities, technologies with favourable characteristics may experience too slow or too limited a diffusion and technologies with no health or cost advantages may be widely used. Initiating activities aimed at facilitating an optimal diffusion of new technologies is therefore an important task for policy makers. So far, there has been very limited research on diffusion of health technologies.
In the process of seeking increased knowledge about diffusion and technological changes several attributes of the technologies have been suggested to be of particular interest [10]; relative advantage (the degree to which a technology is perceived as superior to the relevant existing and competing technology), compatibility (the degree to which a technology is perceived as being consistent with existing values and past experiences), complexity (the degree to which a technology is perceived as difficult to understand and to use), trialability (the degree to which a new technology may be experimented with by the potential adopters before adoption) and observability (the degree to which the outcomes of a technology are visible). A product based technology is available for purchase on the healthcare market, e.g. a pharmaceutical, and method based technologies are mainly developed by health care professionals, e.g. a program for prostate cancer screening [11].
The objective of this study was to describe the diffusion of six main health technologies (PSA tests, radical prostatectomy, radiation therapy, orchiectomy, GnRH-analogues and antiandrogenes) used in the management of prostate cancer, to calculate the costs in Sweden from 1991 to 2002, and to explore factors behind and related to the diffusion.
Section snippets
Population
The total male population in Sweden was approximately 4.5 million in 2002 [12]. Of these, 35 percent were 50 years of age or older and the majority were white males. In Sweden, all inhabitants have a unique registration number enabling registration of diagnostic and therapeutic measures for diseases. All cases of tumour disease are registered in the National Cancer Register. In addition, all cases of prostate cancer are registered in the National Prostate Cancer Register (NPCR) with respect to
PSA-tests
The use of PSA-tests has increased approximately seven-fold during the period 1991–2002, and in 2002 approximately 430,000 tests were performed in Sweden (Fig. 1).
Curative treatment
The number of radical prostatectomies in Sweden has increased from 178 in 1991 to 1,174 in 2002 (Fig. 2). The corresponding increase during the last three years has been approximately 60 percent, from 726 in 1999 to 1,174 in 2002. Radiation therapies with a curative aim have also been utilized to an increasing extent during the period
Sources of data
For completion and optimal correction we obtained and compared data from several population based sources. Data on surgical and radiation procedures were obtained from the NPCR. Since 1998, all health care regions in Sweden register new cases of prostate cancer in the NPCR. The register is updated annually and no variables have been removed; however variables have been added and adapted according to changing views on management of prostate cancer. To ensure high coverage, the NPCR is checked
Conclusions
The utilization patterns of six main health technologies used in the management of prostate cancer illustrates the dynamic development of health care, with old technologies being used less and new technologies coming into use. Major changes include replacement of orchiectomy by chemical castration, and the increasing use of radical prostatectomy, radiation therapy and PSA-tests. These changes in technology have resulted in a great cost increase for prostate cancer care in Sweden without proven
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Editorial comment
2014, UrologyCosts of radical prostatectomy for prostate cancer: A systematic review
2014, European UrologyCitation Excerpt :With a population of elderly men newly diagnosed with PCa, the shift to more expensive PCa treatments may have major public health implications. European studies found an increasing cost for PCa care caused by technological changes in the management of PCa [12,13], and economic considerations are increasingly important for reasonable health care resource allocation in light of budgetary constraints and limited resources. In the United Kingdom, for example, the National Institute for Health and Clinical Excellence requires high-level evidence for a new treatment before providing it to patients and paying for it.
Cost Comparison of Robotic, Laparoscopic, and Open Radical Prostatectomy for Prostate Cancer
2010, European UrologyCitation Excerpt :Although minimally invasive approaches offer the benefit of decreased blood loss and shorter hospital stay [4], the need for more expensive equipment may have a significant impact on health economics. European studies found increasing costs for PCa care, caused by technological changes in the management of PCa [5,6]. We have previously shown that costs for LRP were higher than those for RRP, predominantly due to higher surgical supply and operating room (OR) costs [7].
Efficacy of venlafaxine, medroxyprogesterone acetate, and cyproterone acetate for the treatment of vasomotor hot flushes in men taking gonadotropin-releasing hormone analogues for prostate cancer: a double-blind, randomised trial
2010, The Lancet OncologyCitation Excerpt :Our study shows that men with significant hot flushes during androgen suppression responded better to cyproterone acetate and medroxyprogesterone acetate than to venlafaxine within the 12-week study period. Androgen suppression using GnRH analogues is widely prescribed in prostate-cancer treatment.1 Hot flushes are the most common side-effect of this treatment, and can be very uncomfortable for patients.3
Prostate cancer: Medicoeconomic aspects
2010, Progres en Urologie