Brachytherapy - gentler and cheaper than total surgery

Health cost analysis: Long regeneration times after total removal of the prostate cause high costs

Cologne, 18 April 2006 - Billions of euros in debt burden the statutory health insurance funds. The financial situation in the health care system in Germany is still not in good shape. The consequence: Despite the same or even better effect, new therapies are difficult to obtain in the reimbursement catalogue, even if they are proven to be cheaper than treatment methods that have been financed by the health insurance funds for years. One example: Brachytherapy is used to treat prostate cancer by introducing radiation sources into the prostate gland, giving off radiation continuously and thus reliably and successfully destroying the cancer. This therapy, which has long been medically recognised, is not yet included in the reimbursement list in Germany, even after many years.

Dr. Stephan Neubauer, urologist and medical director of the West German Prostate Center in Cologne, explains:"This prostate cancer treatment based on internal radiation is gentler, in many cases more successful and in the long term even cheaper than the most common form of treatment to date, the radical removal of the prostate gland," said Dr. Stephan Neubauer, urologist and medical director of the West German Prostate Center in Cologne. Above all, long regeneration times after the total operation cause high costs for patients, but above all for employers and health insurance companies. According to a current medical cost analysis of the University of Ulm, the patient is on average 104.4 days off sick after a total operation, while after brachytherapy the patient can leave the clinic the following day and resume work.

Causer of costs: Total operation

A health cost analysis conducted by the University of Ulm allowed 177 patients to be questioned. (All patients were treated with the radical removal of the prostate gland, the so-called prostatectomy, after being diagnosed with prostate cancer and were younger than 56 years of age at the time of the survey and were thus in full employment. The result: After the total operation, the patients were on average 104.4 days off sick. While 121 patients then resumed work, 12 patients were unemployed, 9 were retired due to age and 21 patients retired prematurely due to their cancer. In the period from diagnosis to three years after surgery, the following costs were incurred on average per patient: €465.79 for the patient, €6,569.76 for the employer, €16,356.96 for the health insurance fund, €13,304.88 for the pension insurance fund and €3,912.57 for the employment office.

Brachytherapy: economical and gentle alternative

Depending on the stage of the cancer, two brachytherapy techniques are available: Seed implantation at an early stage and afterloading therapy at an advanced stage or in the case of aggressive tumours. Both forms of treatment are based on the internal irradiation of the cancer and represent an alternative to total surgery while preserving the prostate. This means that the tumour is destroyed by the radiation without damaging the surrounding tissue. During seed implantation, up to 80 short-radiated, smallest radiation sources made of iodine are implanted into the prostate. So-called seeds remain in the prostate gland and continuously emit radiation onto the tumor tissue for several months, thus destroying it. In the afterloading therapy, on the other hand, the prostate is only irradiated for a short period of time, but with a high dose. For this purpose, the urologist introduces special hollow needles into the prostate that are loaded with a previously calculated radiation source. It then moves needle by needle and irradiates the entire prostate gland in just a few minutes. While only one session is required for seed implantation, the treatment in afterloading therapy is repeated at intervals of one week each. The most important advantages for patients: Incontinence and impotence occur only very rarely, whereas many patients suffer from it after total surgery. Regeneration times are extremely short. Brachytherapy is only reimbursed by the statutory health insurance company upon application and examination in individual cases.

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