Brachytherapy – more cost efficient than surgery

Health cost analysis proves: long-term rehabilitation after radical removal of the prostate results in high cost

Cologne, April 18, 2006 – State health insurance companies are suffering from debt amounting to several billion euros. The financial situation of the German healthcare system is disturbing. One of the reasons is that although there are equal or even more beneficial effects, new therapies are not allowed into the reimbursement catalogue, even if they are more cost efficient than the conventional therapies that have been financed by the health insurance companies for a number of years. An example is the brachytherapy, which is applied in the treatment of prostate cancer. In this procedure, radiation sources (seeds) are implanted permanently into the prostate. These radioactive seeds destroy the cancer successfully by emitting radiation to the tumor over a period of several months.  This therapy has long been accepted, but in Germany, the state health insurances companies will not pay for it.

„The on internal radiation based prostate treatment is minimally invasive, meaning the patient experience less discomfort and side effects. Long-term, in many cases it is more successful, and less costly than conventional forms of prostate removal“, explains Dr. Stephan Neubauer, urologist and medical director of the West German Prostate Center in Cologne. Especially the long periods of rehabilitation after radical surgery, are in Germany a high cost factor for employers and health insurance companies. For example, according to the latest healthcare cost analysis introduced by the University of Ulm, after radical surgery, a patient is on sick leave for an average of 104.4 days, while after brachtherapy the patient in most cases can leave the hospital the day after surgery. Patients can resume there normal activities within a few days after the surgery.

Cost generating factor in Germany: Radical Surgery

Within the scope of the health system cost analysis of the University of Ulm, 177 completed a survey. All patients had been treated with the radical prostate removal surgery, the so-called prostatectomy, and were at the time of the survey younger than 56, and thereby employable. The results of the survey revealed that after a radical surgery, the patients averaged 104.4 days on sick leave. While 121 patients were able to return to their jobs after sick leave, 12 patients lost their jobs, 9 patients were eligible for pension due to their age, and 21 patients chose early retirement  because of their remaining illness. Thus, within a period of over three years, starting with the diagnosis until finishing rehabilitation, the following costs were incurred: 465.79 € for the patient, 6569.76 for the employer, 16356.96 € for the health insurance company, 13304.88 € for social security and 3912.57 € for the employment agency.

Brachytherapy: cost efficient and minimal evasive alternative

Depending on the stage of the cancer disease, two types of brachytherapy are available: In the early stage, the seed-Implantation, and in the already advanced stage, or with aggressive tumors, the afterloading therapy. Both treatment techniques are based on an internal radiation of the cancer. They are alternatives (to the radical surgery) preserving the prostate. This means that the tumor is destroyed by precisely targeted radiation without injuring the surrounding tissue. In seed implantations, the smallest radioactive iodine seeds are implanted into the prostate. These destroy the tumor through internal radiation. The so-called seeds remain in the prostate and destroy the tumor by emitting radiation continuously to the tumor tissue over a period of several months.

In the afterloading procedure, the prostate receives radiation only short-term, but with a high dose of radiation. The urologist inserts special hollow needles into the prostate, which are pre-loaded with radioactive sources, the strength of which were calculated prior to treatment. The urologist unloads needle by needle, until the entire prostate has received radiation. Treatment only takes a few minutes. While in seed implantation, only one session is necessary, the afterloading therapy is several times repeated in an interval of one week. The most significant advantages for the patient are that incontinence and impotence only occur very rarely, while many patients undergoing radical surgery suffer from these side effects. Regeneration processes are exceedingly rare. Brachytherapy will only be paid for by the state health insurance companies in individual cases upon request, and upon their evaluation. 

The German text of this article is available under OpenPR