Healthcare resource utilization in a risk based stratified cancer active surveillance (STRATCANS) programme for early prostate cancer

Background Active surveillance (AS) is an increasingly common strategy for managing early prostate cancer. There is however no accepted standard for how AS should be done or what healthcare resources are appropriate. The STRATified CANcer Surveillance programme (STRATCANS) is an evidence based 3-tier risk stratified programme to tailor Active Surveillance (AS). Here we report on its real-world resource utilization following implementation in our unit . Methods Men with a prostate cancer diagnosis and selecting AS were enrolled onto the STRATCANS program. Data on resources used during surveillance was extracted from the clinical records. Per protocol scheduled events (clinic events/MRI/ biopsies), any additional non-scheduled events, and disease progression events were recorded. Total, annualised and per person/year costs were derived using contemporary national tariffs. Comparative resource utilization and costs were modelled against two alternative protocols: A PSA based and MRI intensive protocol. Results Data from 125 men were included for analysis with a median surveillance time of 3.4 years. Overall 84/125 (67.2%) remained on AS throughout. Progression to ≥Cambridge Prognostic Group 3 (endpoint for STRATCANS) occurred in 20/125 (16.0%) men overall and 2/50 (4.0%) of men in the lowest progression risk STRATCANS 1 subgroup. Over the surveillance period there were 593 clinic reviews, 278 repeat MRI and 34 re-biopsies. Only 1 in 10 events were additional to pre-planned scheduled reviews. Overall this translated into a median of 1.2 per person/year for clinic episodes and 0.60 per person/year for MRI. In the STRATCANS1 subgroup this was 1.0 and 0.54 respectively. The STRATCANS protocol cost £124,527 in total equating to an annualised cost of £36,411 or £291 per person/year. For men in STRATCANS1 the annualised and per person/year cost were £11,386 & £228. In comparison, using a non-stratified PSA based protocol, although incurring fewer repeat MRI and re-biopsy, would have been costlier and missed 3 disease progressions. An MRI intensive protocol would not have missed any progressions but was considerably more resource intensive. Conclusion The STRATCANS risk stratified programme represents a resource effective way to deliver safe AS in clinical practice, comparing favourably against other proposed protocol.