Pd43-11 the Financial Impact of a Positive Margin During Radical Prostatectomy: an Analysis on the Odds of Receiving Adjuvant Radiation Therapy
Year: 2020
Type: article
Abstract: You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II (PD43)1 Apr 2020PD43-11 THE FINANCIAL IMPACT OF A POSITIVE MARGIN DURING RADICAL PROSTATECTOMY: AN ANALYSIS ON THE ODDS OF RECEIVING ADJUVANT RADIATION THERAPY Alberto Martini, Ethan Wajswol*, Kathryn Marqueen, Ugo Falagario, Nikhil Waingankar, John Pfail, Fahad Khan, Ashutosh Tewari, Richard Stock, and Ardeshir Rastinehad Alberto MartiniAlberto Martini More articles by this author , Ethan Wajswol*Ethan Wajswol* More articles by this author , Kathryn MarqueenKathryn Marqueen More articles by this author , Ugo FalagarioUgo Falagario More articles by this author , Nikhil WaingankarNikhil Waingankar More articles by this author , John PfailJohn Pfail More articles by this author , Fahad KhanFahad Khan More articles by this author , Ashutosh TewariAshutosh Tewari More articles by this author , Richard StockRichard Stock More articles by this author , and Ardeshir RastinehadArdeshir Rastinehad More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000930.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate cancer is the most common male malignancy and the one that has the highest positive surgical margin (PSM) rate. In case of a PSM, the appropriateness of adjuvant radiation therapy (aRT) should be discussed. To our knowledge, the financial burden of PSMs on health systems has not been investigated. In this study, we aimed to estimate the financial impact of positive surgical margin (PSM) during radical prostatectomy based on the odds of receiving aRT. METHODS: We relied on the National Cancer Data Base to identify individuals treated with radical prostatectomy. The attributable risk fraction (ARF) of PSMs on receiving aRT was estimated from a logistic regression predicting aRT administration. The analysis was adjusted for patients’ characteristics, socio-demographic factors and tumor characteristics. The aRT cost for the year 2019 aRT was calculated using physician fee schedule and the outpatient payment system. The fraction of this cost attributable to a PSM was estimated according to its ARF. RESULTS: Of the 230,175 identified men, 22.8% had a PSM. This occurrence was more frequent in older, non-Caucasian, comorbid patients with worse tumor characteristics and lower socio-economic indicators and more frequently documented in non-academic institutions (all p<0.001), Figure 1. A total of 11,585 (5%) patients received aRT, 7,698 (3.3%) of them had a PSM on their final pathology specimen. When controlling for patients’, socio-demographic and pathologic variables, men with PSM had 3.79 odds of receiving aRT (95% confidence intervals [CI]: 3.63,3.96; p<0.001) relative to those with negative margins. The ARF of the presence of a PSM on aRT was 44% (95% CI: 42-45%). The attributable cost of a PSM was calculated as $17,356 (95% CI: $16,567-17,751). Assuming 60,000 prostatectomies in 2019 and similar trends of PSM and aRT, the overall health burden attributable to PSMs is calculated to be $52,068,000 (95% CI: $49,701,000-53,253,000). CONCLUSIONS: We estimated the aRT cost attributable to the presence of a PSM to be approximately $17,000, resulting in over 52 million dollars in spending on aRT in 2019. Strategies to reduce PSMs could potentially have a tremendous impact on the overall health costs of surgically-treated PCa. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e904-e905 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alberto Martini More articles by this author Ethan Wajswol* More articles by this author Kathryn Marqueen More articles by this author Ugo Falagario More articles by this author Nikhil Waingankar More articles by this author John Pfail More articles by this author Fahad Khan More articles by this author Ashutosh Tewari More articles by this author Richard Stock More articles by this author Ardeshir Rastinehad More articles by this author Expand All Advertisement PDF downloadLoading ...
Source: The Journal of Urology
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W3022498471