Beyond Clinical Outcomes: A Patient-Centered Decision Support Tool for Localized Prostate Cancer Treatment

Abstract

Shared decision-making for localized prostate cancer (PCa) requires balancing oncologic control with functional outcomes and the patient and caregiver burden of care. Existing economic tools emphasize payer costs or direct out-of-pocket expenses and rarely quantify indirect burden (eg, missed work, travel) or caregiver disruption. We developed a patient-centric tool to compare patient- and caregiver-level outcomes across common localized PCa management strategies to inform shared decision-making and counseling. We developed the tool from a US patient perspective comparing active surveillance, irreversible electroporation, radiotherapy, and radical prostatectomy over 1- and 5-year horizons. Inputs were derived from peer-reviewed literature, guidelines, payer fee schedules/policies, and gray sources. Patient cost-sharing was estimated for Original Medicare, Medicare Advantage, and Commercial coverage. Indirect burden inputs were sourced from published data and national statistics. Assumptions were informed by input from a board-certified urologist and reviewed by a patient advocate. The tool spans pre-, peri-, and post-treatment follow-up. User-selected parameters include time horizon, insurance type, site of care, and active surveillance progression at year 5. Outputs include patient out-of-pocket costs (medical and indirect), patient and caregiver missed workdays and wage loss, 1-year complication rates, and 1- and 5-year progression-free survival. Scenario testing demonstrated appropriate responsiveness to insurance type, site of care, and disease trajectory. This tool supports point-of-care counseling by quantifying patient- and caregiver-relevant tradeoffs in costs, time burden, and functional outcomes across localized PCa strategies.