Real-world economic burden of metastatic castration-resistant prostate cancer before and after first-line therapy initiation
Creators: name: Kaye, Deborah R.
name: Khilfeh, Ibrahim
name: Muser, Erik
name: Morrison, Laura
name: Kinkead, Frederic
name: Urosevic, Ana
name: Lefebvre, Patrick
name: Pilon, Dominic
name: George, Daniel J.
Publisher: name: Taylor & Francis
Year: 2024
Subjects: subject: Medicine
subject: Pharmacology
subject: Sociology
subject: FOS: Sociology
subject: Cancer
subject: Science Policy

description: To describe healthcare costs of patients with metastatic castration-resistant prostate cancer (mCRPC) initiating first-line (1 L) therapies from a US payer perspective. Patients initiating a Flatiron oncologist-defined 1 L mCRPC therapy (index date) on or after mCRPC diagnosis were identified from linked electronic medical records/claims data from the Flatiron Metastatic Prostate Cancer (PC) Core Registry and Komodo’s Healthcare Map. Patients were excluded if they initiated a clinical trial drug in 1 L, had &lt;12 months of insurance eligibility prior to index, or no claims in Komodo’s Healthcare Map for the Flatiron oncologist-defined index therapy. All-cause and PC-related total costs per-patient-per-month (PPPM), including costs for services and procedures from medical claims (i.e. medical costs) and costs from pharmacy claims (i.e. pharmacy costs), were described in the 12-month baseline period before 1 L therapy initiation (including the baseline pre- and post- mCRPC progression periods) and during 1 L therapy (follow-up). Among 459 patients with mCRPC (mean age 70 years, 57% White, 16% Black, 45% commercially-insured, 43% Medicare Advantage-insured, and 12% Medicaid-insured), average baseline all-cause total costs (PPPM) were $4,576 ($4,166 pre-mCRPC progression, $8,278 post-mCRPC progression). Average baseline PC-related total costs were $2,935 ($2,537 pre-mCRPC progression, $6,661 post-mCRPC progression). During an average 1 L duration of 8.5 months, mean total costs were $13,746 (all-cause) and $12,061 (PC-related) PPPM. The cost increase following 1 L therapy initiation was driven by higher PC-related outpatient and pharmacy costs. PC-related medical costs PPPM increased from $1,504 during baseline to $5,585 following 1 L mCRPC therapy initiation. All analyses were descriptive; statistical testing was not performed. Incremental costs of progression to mCRPC are significant, with the majority of costs driven by higher PC-related costs. Using contemporary data, this study highlights the importance of utilizing effective therapies that slow progression and reduce healthcare resource demands despite the initial investment in treatment costs. Prostate cancer is one of the most common causes of cancer death in men. While outcomes are good if treated early, some patients may develop advanced disease that is more difficult and costly to treat. The most advanced form is late-stage hormone-resistant prostate cancer. Previous studies found that healthcare costs and use of medical services increase when prostate cancer advances to this stage. New medications are available, but their costs are not well known. Our study reviewed clinical information and health insurance data to estimate the healthcare costs and medical services used by 459 men who received drug treatment for late-stage hormone-resistant prostate cancer between 2017 and 2021 in the United States. In the year before a diagnosis and the start of drug treatment for late-stage hormone-resistant prostate cancer, total healthcare costs per month were approximately $4,000. After diagnosis of but before drug treatment for late-stage hormone-resistant prostate cancer, monthly healthcare costs nearly doubled, to approximately $8,000. Most of the additional $4,000 were specifically related to prostate cancer. After the start of the first drug treatment, total healthcare costs increased to approximately $13,500 every month. Most of the costs were related to medical office/clinic visits and medications. As their disease progressed, men received additional therapies, and office/clinic visits and use of chemotherapy also increased. These results emphasize the high healthcare costs and large number of medical services used by men with late-stage hormone-resistant prostate cancer. Therapies that slow progression to advanced prostate cancer may help to reduce high healthcare costs.