The “Triple Aim” of advances in healthcare is to 1) improve access to care for all populations; 2) reduce the per capita costs of care; and 3) improve the individual experience of care.1 It frequently is difficult for a newly introduced therapeutic intervention to achieve all three aims.

While innovation may improve patient experience and outcomes and improve access, it invariably increases the cost of care. Conversely, if a newly introduced technology increases the cost of care delivery, it may be difficult for all to afford that care, thereby limiting access. Focused ultrasound is one of the few technological innovations that supports all three legs of this stool, and its ability to achieve focal ablation of prostate cancer is a perfect “poster child” to support this claim.

When used for focal ablation of prostate cancer, high-intensity focused ultrasound (also known as HIFU) has been repeatedly shown in studies from around the world to produce disease control equivalent to or better than current standards of care like radiation therapy and prostatectomy. It does so, however, with a much lower side effect profile.2,3,4,5

Chart: Treating Prostate Cancer: Comparison of Side Effect Profile
Urinary Continence   Focal HIFU Prostatectomy Radiation Therapy
  0-1 pad/day 100% 87% --
  0 pads/day 98% 65% --
  Pad & leak free 80% 32% 53%
Erectile Function Penetration 85% 30% 28%
Ejaculation   80% 0% 30%
Rectal Continence   100% 97% 90%

 

HIFU is a treatment that can reach, and be accommodating to the life needs of, a much greater number of men then is possible with surgery or radiation therapy. Among its benefits, HIFU is a minimally invasive, outpatient treatment that allows men to return to work within several days rather than the multiple weeks required for a prostatectomy. It also uses equipment that costs a fraction of that required for radiation therapy or a robotic prostatectomy.

When HIFU is used to focally treat prostate cancer, it achieves improvement in outcomes, individual experience of care, and access at significantly monetary savings to society. HIFU is appropriate for about 60 to 70 percent of men with prostate cancer. If all men appropriate for treatment were to be treated in this way, the five-year cost savings across Medicare and commercial insurance carriers would exceed $8 billion. These savings come from the reduced cost of:

  • Primary intervention (HIFU costs about 50% less than a prostatectomy and 70% less than a course of radiation therapy)
  • Treating side effects (as a single example, incontinence supplies cost $100 to $200 per month every month for the rest of the man’s life)
  • Treatment for recurrent disease (20 to 40 percent of men treated with radiation therapy are on androgen deprivation therapy at $5,000 to $10,000 per year)

Furthermore, men are back to work within several days of their treatment, vastly quicker than the four to six weeks or more required following a prostatectomy, and this results in a significant productivity savings to society.6,7

The savings in the face of equal quality of care and improved patient experience can also be seen with other focused ultrasound treatments. To give just one additional example, focused ultrasound can be used to treat essential tremor (ET), the most common movement disorder affecting an estimated three percent of the population or approximately 10 million individuals in the US. ET is commonly viewed as a relatively benign disease. However, the associated disabling aspects of ET, such as significant tremor of the hands, can impair a patient’s ability to eat, shave, write, perform household activities, and function in the workplace.

ET is commonly treated with surgical thalamotomy or deep brain stimulation, both of which are invasive brain procedures. Focused ultrasound ablation achieves the same clinical benefits but is a minimally invasive outpatient procedure that does not require an operating theater. The average Medicare savings on a per-patient basis can be estimated at upwards of $30,000 per patient over five years.8

It is difficult to advocate for medical procedures that reduce cost and increase access but do not deliver the same level of clinical results seen with existing standards of care. However, when that reduced cost and increased access is associated with improved clinical outcomes AND improved patient experience, it becomes difficult to not advocate for its adoption as a better standard of care than what currently exists. Focused ultrasound achieves the Triple Aim in almost all of its uses. It deserves advocacy at the highest level possible.

References
1Berwick DM, Nolan TW, Whittington J. The Triple Aim: Care, Health, And Cost. Health Affairs Vol. 27, No. 3 Health Reform Revisited. May/June 2008. 
2Guillaumier S, et al. A Multicentre Study of 5-year Outcomes Following Focal Therapy in Treating Clinically Significant Nonmetastatic Prostate Cancer. Eur Urol. 2018 Oct;74(4):422-429.
3Tyson MD II et al. Effect of Prostate Cancer Severity on Functional Outcomes After Localized Treatment: Comparative Effectiveness Analysis of Surgery and Radiation Study Results. Eur Urol. 2018
4Resnick MJ et al. Contemporary Prevalence of Pretreatment Urinary, Sexual, Hormonal, and Bowel Dysfunction. Cancer. 2014
5Protopapa E et al. TRUENTH UK Post Surgery Urinary Function in the 1st Post-operative Year in a 1,000 Man Contemporary Radical Prostatectomy Cohort. AUA, 2018
6Epstein AJ, Groeneveld PW, Harhay MO, Yang F, Polsky D. Impact of Minimally Invasive Surgery on Medical Spending and Employee Absenteeism. JAMA Surg. 2013;148(7):641–647.
7Bijlani A et al. A Multidimensional Analysis of Prostate Surgery Costs in the United States: Robotic-Assisted versus Retropubic Radical Prostatectomy. Value in Health. 2016;19(4): 391 – 403.
8Schank A et al. Magnetic Resonance-Guided Focused Ultrasound Neurosurgery for Essential Tremor: A Health Technology Assessment. Health Quality Ontario. 2018 May 3;18(4):1-141.

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