Wednesday, October 14, 2009

Prostate Surgery

An article in yesterday's New York Times talks about an article that describes different results from different types of prostate surgery. A key finding is that minimally invasive surgery is associated with similar outcomes with respect to cancer, fewer short-term side effects, but more long-term side effects.

Why is this "economics"? Quite simply it demonstrates tradeoffs. A main short-term risk that is referred to is pneumonia. Main long-term risks are impotence and incontinence. This is something that society in general might have opinions about and is certainly something that individual men who are undergoing prostate cancer treatment have opinions about. This can be analyzed using a cost-effectiveness analysis to describe average results within a population and can also be analyzed at the individual level looking at a "decision support system" which is intended to provide information for an individual to make decisions What are the costs and risks associated with pneumonia? What are the costs and risks associated with incontinence and impotence? Is there specific information about these risks for men just like the patient in question?

It is also economics because a key question is why there is the demand for a service that has not been shown to be clearly superior. This is an interesting question about technology diffusion, marketing, and how hospitals make decisions about the expected return on investment from the acquisition of new technology. Hospitals that calculated a favorable return on investment invested in new technologies and now need to achieve the return on investment.

As a result, the more expensive and less invasive technology may continue to penetrate the market despite mixed clinical evidence. This is another point at which some additional regulation or oversight of investment and coverage decisions may help the market for medical care.


  1. After reading the article on different types of results from different types of prostate surgery and having cared for men with prostate cancer in the past, I know how personally and professionally this disease affects men. I was at dinner tonight and asked the men (3) at the dinner what choice they would make based on the reported results. All the men stated they would rather have pneumonia then be faced with long-term side effects of incontinence and impotence. I asked the men to further elaborate on this and each man stated the long-term effects would mentally affect them terrible. I then started to wonder what the economic costs of treating any depression that could occur with the long-term effects in men would be. I imagine a large population of men faced with the long-term effects of minimally invasive prostate surgery who developed depression over the symptoms would need anti-depressants and counseling-all additional economic costs in addition to the long-term effects. It was interesting to read in the article how the minimally invasive surgery was directly marketed to men through the internet, radio and print media-much like the drug companies do for erectile dysfunction. You cannot watch a Sunday football game without viewing 10 or more commercials on erectile dysfunction. This was a large study sample of men and should reinforce that the risks and benefits of any surgery are real and potentially economically and psychologically damaging.

  2. Interesting points. I recognize the problems with impotence and incontinence but neither of those will kill you, at least not directly. Pneumonia can. That is an interesting choice. I'd lean toward avoiding pneumonia myself.