Cost of Prostate Cancer Treatments

From a study at UCLA published in the July 2016 Journal of Cancer:
These costs are for the treatment of low risk cancer:

AS for 5 years $7298
IMRT $23,565
Low dose Brachy $8978
High Dose Brachy $11,448
SBRT $11,665
Robotic Surgery $16.946

Total treatment costs for PC treatments in 2020 projected at $18.5 billion

I'm sure that study was using treatment cost averages but, for some perspective: SBRT at Cleveland Clinic ,Therapeutic Radiology Svc = $19,625 was the provider charge, Highmark member rate was $11,343, times 5 treatments. With fiducials, simulation, balloons, planning etc., the total provider charge at CC for SBRT was over $100,000.

To be fair, my Dx is intermediate, not low risk. The moral of the story is if your coming to Cleveland for SBRT, please make sure you check with your insurance people.

Interesting. The study from UCLA under estimates the cost for High Dose Brachy at UCLA. At least it underestimates the cost my health insurance co. was billed.

John T said...
From a study at UCLA published in the July 2016 Journal of Cancer:
These costs are for the treatment of low risk cancer:

AS for 5 years $7298
IMRT $23,565
Low dose Brachy $8978
High Dose Brachy $11,448
SBRT $11,665
Robotic Surgery $16.946

Total treatment costs for PC treatments in 2020 projected at $18.5 billion

What is billed us always an artificially high number and should never be used for anything. Always use the actual reimbursement amount that is paid by your insurance and/or Medicare. No provider expects to get what they bill.

My total cost for HDRBT and IMRT was right at $30,000 six years ago. Regarding Cleveland Clinic please report the actual reimbursement. The high figure you cite for IMRT is meaningless if that is merely what they billed.

"Plan paid to Provider", Highmark BC/BS to Cleveland Clinic, all things related to SBRT, Q1 and Q2 of 2017, just under $140,000. On average, a 40% discount to the "Provider Charge".

Hate to bring the Task Force into this, but thanks to them my costs are a lot higher than they might have been, especially when I hit the Xtandi/Zytigia circuit.

Just finished IMRT......I am a Veteran and was ab;e to get outside RO to do 39 treatments. Cost was over 60,000.

Hal, doctors and hospitals are very profitable based on what they collect. I certainly don't see any of them going out of business. In the Atlanta area there is a huge amount of new construction for clinics and hospital expansion. They wouldn't be doing this if they weren't making money. Like I said the billed amount is artificially high and does not reflect their cost of doing business. And actually many businesses mark down their prices, look at Jos A Bank, the clothier. Every day is a 50% discount on something. Cars are artificially marked up by an average of 18%, no one pays MSRP. Look at the everyday sale at all the furniture chains. These have always been known for a 50% markup, thus the constant discounts.

Fairwind, when you don't have insurance or any other third party payor you simply tell the provider. You will routinely pay the price they have negotiated with the insurance companies, not the billed amount. You can certainly negotiate the price and cash up front always helps. If you can't or won't pay that and it is a non emergency, they can deny care, but for serious things this rarely happens. All hospitals have financial/social worker representatives that handle this with people that are not insured to work out arrangements. If the patient is eligible many hospitals will assist them with getting Medicaid.

If all providers were limited to the reimbursement rate of Medicare then there would be tremendous adjustments to be made. Their real profit margin comes from the higher negotiated prices with commercial insurance companies and non-governmental payors (labor unions, benefits associations, self insured companies, etc). It has been often reported that this differential is 25-30% in most cases.

The only way to see exactly what was paid to the provider by the payor is to look at the Explanation of Benefits (EOB). This is required to be sent to the patient whenever a third party payor (Medicare, insurance, etc) makes a payment on behalf of the patient. It will show the amount billed, the adjustments to the bill, the amount reimbursed by the third party, and then the amount the patient is liable for. I read the same report that JohnT referenced and it looks clear that cost is what was actually paid but the payor and patient, not what was billed by the provider.

My nephew and his wife are physicians and have always worked in a group practice, they have productivity goals to meet and their salary and bonuses depend on meeting those goals. To me it's a huge conflict of interest but I get the part where the group needs to not just survive but flourish.

My out-of-pocket expense at MDA so far has been zero I have spent quite a bit of money on lodging and other incidental expenses.

The medical billing system is crazy, and no private company could survive operating like that.
Just imagine a grocery store in which there are no prices displayed. Each month a shopper pays $1,000, for which he gets the right to get all his food. The checker scans everything and sends the bill to an insurance company or the govt. the consumer sees nothing, he could be paying $5 or $.25 for a can of pees, he doesn't know what anything costs. How could such a system ever be efficient?
The sad truth is that at 17.5% of GDP for medical costs no system will work, and at 9% most any system would work, private, govt, single payer or multi insurance. The only way to reduce our medical costs is through rationing, like every other industrial country. This is intolerable for Americans so we continue to skirt the issue and play with ideas that will never reduce costs, but in fact increase them.
A practical effect of rationing, I had a cavity filled in Europe a few Years ago and the dentist didn't use novicane. He said it costs too much and is not used for routine drilling, awful experience.

My first radiation even (non PC) in year 2000, was right at 250K. I paid nothing. My open RP, cost over 115K including hospital time. My Urostomy surgery was around 150K including hospital time. My 2nd radiation event (PC related) was still over 150k. My 30 hyperbaric treatments prior to major dental surgery, was 75k, all paid for by the VA. The dental and jaw surgery was over 15k, again VA paid.

A lot of money has been spent to keep me going, not sure me or anyone else is worth the bucks.

Island,
Total income tax today is about 17% of GDP. Medical costs are 17% so taxes would have to increase substantially. California is now lookin at single payer and added cost is equal to it's current budget. No system works when are costs are where they are now including single payer. Bring costs down to 10% and it's manageable.

I read through the prior comments. There are cranes at all of the Columbus, Ohio hospitals.

Cost for Provenge in 2020 - 3 treatments of Provenge $378,000 (Aetna paid)
Provenge billed - $546,000