PII S0360-3016(99)00323-5 CLINICAL INVESTIGATION Prostate THE COST EFFECTIVENESS OF 3D CONFORMAL RADIATION THERAPY COMPARED WITH CONVENTIONAL TECHNIQUES FOR PATIENTS WITH CLINICALLY LOCALIZED PROSTATE CANCER ERIC M. HORWITZ, M.D., ALEXANDRA L. HANLON,PH.D., WAYNE H. PINOVER, D.O., AND GERALD E. HANKS, M.D. Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA Background: We previously demonstrated the advantages of three-dimensional conformal radiation therapy (3DCRT) in improved rates of biochemical (bNED) control in certain subsets of patients with clinically localized prostate cancer. However, in this era of cost consciousness and limited resources, the cost effectiveness of 3DCRT compared with conventional external beam irradiation (CRT) remains unexamined. Methods and Materials: Between October 1, 1987 and November 30, 1991, 193 patients with clinically localized prostate cancer received definitive external beam irradiation at Fox Chase Cancer Center. The 1998 Medicare fee schedule was used to determine treatment charges and to provide a reference for a national comparison. Complete charges for pretreatment work-up, treatment, and follow-up were tabulated for each patient. The mean total charges (MTC) using the Lin method of estimating medical costs was used to analyze and compare costs between groups. A matched case/control analysis was performed to further evaluate the effect of cost between techniques. The median follow-up was 72 months (range 3–118). Results: The overall 5-year actuarial rate of bNED control was 41% and 53%, respectively, for the CRT and 3DCRT patients (p  0.03). The MTC for the CRT patients was $10,544.53. For the 3DCRT patients, the MTC was $8,955.48. The sample mean of the total costs from the observed deaths for the two patient groups by follow-up interval ranged from $9,800.63 to $59,635.01 for the CRT patients to $17,259.00 to $24,250.38 for the 3DCRT patients. No statistically significant difference in cost was observed between groups using the matched case/control analysis. Conclusion: Initial work-up and treatment costs were greater for patients treated with 3DCRT compared with patients treated with conventional techniques. However, with longer follow-up, the mean total cost of treatment was not statistically different between the two treatment groups. Because of improved rates of bNED control for these patients and the increased costs associated with the treatment of a greater fraction of patients with recurrent disease following CRT, 3DCRT was cost effective for patients with clinically localized prostate cancer. © 1999 Elsevier Science Inc. Prostatic neoplasms, Prostate specific antigen, Cost effectiveness, Biochemical control, Radiation therapy, 3-dimensional conformal radiation therapy. INTRODUCTION An important issue for all of medicine, including oncology, in the 1990s is how to incorporate the many new technol- ogies and advances into the current treatment armamentar- ium and use them in a cost-effective manner. In the era of prostate specific antigen (PSA), the clinical utility and ef- fectiveness of many conventional treatments for prostate cancer (i.e., surgery and radiation) have been questioned. This has led to the search for and development of new and aggressive treatments and strategies to treat this disease. These new therapies have been costly, and in this era of limited resources (both on a societal and individual level), the most appropriate and effective use of these treatments is critical. Three-dimensional conformal radiation therapy (3DCRT) is one new treatment modality that has been developed during the past decade to treat various cancers. One hypothesis which led to the development of 3DCRT is that the safe delivery of higher radiation doses to the tumor (target) while sparing surrounding normal tissue would result in improved rates of local control, distant metastases-free survival, and ultimately, overall survival Presented at the 40th Annual Meeting of the American Society of Therapeutic Radiology and Oncology, Phoenix, Az, October 25–29, 1998. Reprint requests to: Eric M. Horwitz, M.D., Fox Chase Cancer Center, Department of Radiation Oncology, 7701 Bur- holme Avenue, Philadelphia, PA 19111. Tel: (215) 728-2995; Fax: (215) 214-4038; E-mail: EM_Horwitz@fccc.edu. Acknowledgments—The authors would like to thank Ruth Peter, R.N., Clinical Manager of the prostate cancer database, for her assistance with data collection in the preparation of this manu- script, and Alan Howald, Director of Network Business Operations for information regarding treatment costs. Accepted for publication 26 May 1999. Int. J. Radiation Oncology Biol. Phys., Vol. 45, No. 5, pp. 1219 –1225, 1999 Copyright © 1999 Elsevier Science Inc. Printed in the USA. All rights reserved 0360-3016/99/$–see front matter 1219