The significant costs of prostate cancer management—An analysis from a Caribbean hospital

Abstract

Objectives

The objective of this paper is to analyse the annual costs associated with the diagnosis and treatment of prostate cancer at San Fernando General Hospital, a large, public hospital in Trinidad.

Materials and Methods

A prospective cost-of-illness study analysed 1 month of all prostate cancer-related events at San Fernando General Hospital. These included inpatient admissions, outpatient visits and surgical procedures. All resources utilized during these visits were logged, itemized and assigned a cost via the Costing Unit of San Fernando General Hospital (SFGH). The annual cost was extrapolated.

Results

Two hundred eight outpatient visits and eight acute presentations were recorded for the month in addition to scheduled surgical presentations. An estimated 2496 outpatient visits and 96 acute admissions occurred annually. The mean age of presenting patients was 69 years old, with the majority (61%) of patients of African ethnicity. The overall estimated cost to the Regional Health Authority was TTD $14052157.66 (USD $2066493). Outpatient visits related to screening, diagnosis or management of prostate cancer, including prostate biopsies, comprised the majority of the costs (57%), while nephrostomies related to upper urinary tract obstruction from prostate cancer contributed least (0.7%). The total cost of metastatic disease was disproportionate to its presentation, with 17% of cases being metastatic but contributing 32% toward overall cost. Of cases with a documented chief complaint, visits related to cancer diagnostics, presentations with symptoms of prostate cancer and biopsies contributed to two thirds of the total cost, while follow-up visits for previously diagnosed prostate cancer contributed to one third.

Conclusion

This analysis shows that prostate cancer has a significant financial burden on the Trinidadian economy. Efforts must be dedicated to early screening and prevention, and policymakers should be aware of the economic impact of the disease when making budgetary allocations. Although diagnostics can be costly, it likely minimizes larger costs associated with extensive treatment and acute hospitalizations related to metastatic disease, as seen in this study.