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cost effective, but this is difficult to assess given the many
patient-, physician-, and system-level factors that affect
outcomes after prostate cancer treatment.
4. Conclusions
In conclusion, treatment with new technologies is costlier
than treatment with traditional technologies. However,
given the overall low quality of evidence and the incon-
sistencies across studies, precise differences in costs remain
unclear. Moreover, attempts to estimate whether this
increased cost is worth it are hampered by the uncertainty
surrounding improvements in outcomes, such as cancer
control and side effects of treatment. However, understand-
ing the value of treatment with new technologies will
become increasingly important as society and policy makers
are moving toward accountable care organizations, bundled
payments, and value-based reimbursement Since value
is definedas outcomes relative to cost wewill needmore
accurate ways of capturing cost and outcomes of treatment
using approaches such as time-driven activity-based costing
and prospective population-based prostate cancer
registries . We encourage clinicians and patients to
participate in such registries whenever possible.
Author contributions: Florian Rudolf Schroeck had full access to all the
data in the study and takes responsibility for the integrity of the data and
the accuracy of the data analysis.
Study concept and design: Schroeck, Jacobs.
Acquisition of data: Schroeck.
Analysis and interpretation of data: Schroeck, Jacobs.
Drafting of the manuscript: Schroeck, Jacobs.
Critical revision of the manuscript for important intellectual content:
Bhayani, Nguyen, Penson, Hu.
Statistical analysis: None.
Obtaining funding: Schroeck, Jacobs.
Administrative, technical, or material support: Schroeck.
Supervision: Schroeck, Hu.
Other: None.
Financial disclosures: Florian Rudolf Schroeck certifies that all conflicts
of interest, including specific financial interests and relationships and
affiliations relevant to the subject matter or materials discussed in the
manuscript (eg, employment/affiliation, grants or funding, consultan-
cies, honoraria, stock ownership or options, expert testimony, royalties,
or patents filed, received, or pending), are the following: Florian
Schroeck is site principal investigator (without compensation) for a
clinical trial sponsored by Eleven Biotherapeutics/Viventia. Bruce Jacobs
is a consultant for ViaOncology. Paul Nguyen has consulted for
Nanobiotix and was an unpaid consultant to Augmenix.
Funding/Support and role of the sponsor: Florian Schroeck is supported in
part by the Department of Veterans Affairs, Veterans Health Adminis-
tration, VISN1 Career Development Award, the Dow-Crichlow Career
Development Award in Surgery, Department of Surgery, Dartmouth-
Hitchcock Medical Center, and the Conquer Cancer Foundation Career
Development Award. Bruce Jacobs is supported in part by the National
Institutes of Health Institutional KL2 award (KL2TR001856), the
GEMSSTAR award (R03AG048091), and the Jahnigen career develop-
ment award. Opinions expressed in this manuscript are those of the
authors and do not constitute official positions of the U.S. Federal
Government or the Department of Veterans Affairs.
Acknowledgments: We would like to acknowledge research librarians
Loretta M. Grikis and Heather B. Blunt for their outstanding assistance
with the systematic literature search.
Appendix A. Supplementary data
Supplementary data associated with this article can be
found, in the online version, at
.
References
[1]
.
[2]
.
[3]
[4]
[5]
.
[6]
.
[7]
[8]
[9]
.
[10]
[11]
[12]
.
[13]
[14]
[15]
[16]
.
[17]
.
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