Carmen Maccagnano1, Emanuela Cagna1, Matteo Corinti1, Antonello Paulesu1, Patrizio Armeni2, Lorenzo Fenech2, Francesca Leucci2, Giario Natale Conti1
  • 1 ASST Lariana Ospedale Sant'Anna (San Fermo della Battaglia)
  • 2 SDA Bocconi School of Management (Milano)


The critical evaluation of a new modality of treatment which employs a new technology has to be considered in the context of “Health Technology Assessment” (HTA). This analysis lead to documents whose utility is essential both for National Health System and the stakeholders, i.e. subjects who are interested in the technology and who can judge it according different point of view, varying from costs to clinical references. We analyzed the economic impact of the introduction of an alternative treatment modality, i.e. High Intensity Focused Ultrasound (HIFU) in the context of the Prostate Cancer Unit (PCU) in Our centre.
The PCU is a multidisciplinary team (MDT), constituted by an Urologist, a Medical Oncologist and a Radiation Oncologist, who manage almost 100 case of prostate cancer (PCa) per year, according to the position paper of European School of Oncology. The capacity of offering to the patients both the common and the alternative treatment modalities, related to clinical experience of the Centre, plays a fundamental role for the correct management of patients with PCa.

Materials and Methods

We retrospectively analyzed all the patients affected by Pca and evaluated by PCU during 2015. We selected low risk patients, according to Epstein’s criteria.
Thus, we calculated and compared the costs of the four treatment modalities available in Our Centre for these pts: active surveillance according to PRIAS (AS) , radical prostatectomy (open –RRP- or robotic –RARP-), radiation therapy [3D-conformational (3D-CRT), Imaging Modulated Radiation Therapy (IMRT), Volumetric Modulated Arc Therapy (VMAT), with or without markers] and HIFU.
We also reviewed the literature searching for the following key words: “prostate cancer”, “active surveillance”, “prostatectomy”, “ radiation therapy” , “HIFU” and “costs”.


In our Centre 360 patients with PCa were evaluated by PCU in 2015.
During the same year we executed 500 prostate biopsy, among these, 146 pts were affected by low risk PCa.
The partition of patients, according to chosen treatment modality, is described in table 1.
Table 2 evidences the costs of every treatment modality.


See results


RT represents the most frequent treatment modality for low risk PCa in Our Centre. The costs are intermediate between AS (considering the whole time of 7 years) and the robotic surgery (8000 €, 8300 € e 12000 €, respectively). According to both literature and clinical experience of other centers, the RARP showed the highest costs. The literature review about HIFU did not evidence any study about the efficacy; consequently we focuses on costs only, which are inferior to other treatments, including RRP.


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