Characterizing the real-world economic burden of metastatic castration-sensitive prostate cancer in the United States
Creators: name: Kaye, Deborah R.
name: Khilfeh, Ibrahim
name: Muser, Erik
name: Morrison, Laura
name: Kinkead, Frederic
name: Lefebvre, Patrick
name: Pilon, Dominic
name: George, Daniel
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 resource utilization (HRU) and costs of patients with metastatic castration-sensitive prostate cancer (mCSPC). Linked data from Flatiron Metastatic PC Core Registry and Komodo’s Healthcare Map were evaluated (01/2016-12/2021). Patients with chart-confirmed diagnoses for metastatic PC without confirmed castration resistance in Flatiron who initiated androgen deprivation therapy (ADT) monotherapy or advanced therapy for mCSPC in 2017 or later (index date) with a corresponding pharmacy or medical claim in Komodo Health were included. Advanced therapies considered were androgen-receptor signaling inhibitors, chemotherapies, estrogens, immunotherapies, poly ADP-ribose polymerase inhibitors, and radiopharmaceuticals. Patients with &lt;12 months of continuous insurance eligibility before index were excluded. Per-patient-per-month (PPPM) all-cause and PC-related HRU and costs (medical and pharmacy; from a payer’s perspective in 2022 $USD) were described in the 12-month baseline period and follow-up period (from the index date to castration resistance, end of continuous insurance eligibility, end of data availability, or death). Of 871 patients included (mean age: 70.6 years), 52% initiated ADT monotherapy as their index treatment without documented advanced therapy use. During baseline, 31% of patients had a PC-related inpatient admission and 94% had a PC-related outpatient visit; mean all-cause costs were $2551 PPPM and PC-related costs were $839 PPPM with $787 PPPM attributable to medical costs. Patients had a mean follow-up of 15 months, during which 38% had a PC-related inpatient admission and 98% had a PC-related outpatient visit; mean all-cause costs were $5950 PPPM with PC-related total costs of $4363 PPPM, including medical costs of $2012 PPPM. All analyses were descriptive; statistical testing was not performed. Treatment effectiveness and clinical outcomes were not assessed. This real-world study demonstrated a significant economic burden in mCSPC patients, and a propensity to use ADT monotherapy in clinical practice despite the availability and guideline recommendations of advanced life-prolonging therapies. Prostate cancer is one of the most common causes of male cancer death. Almost 1/10 men who are diagnosed early develop advanced disease. Androgen deprivation therapy (ADT), which reduces male hormone levels to slow prostate cancer growth, is part of the standard care for early-stage and advanced/metastatic hormone-sensitive prostate cancer. This form of cancer still responds to hormonal treatment. Recently, new advanced therapies targeting cancer in different ways than ADT and offering benefits in survival and disease progression have become available and are associated with improved survival compared to treatment with only ADT. However, the usage and costs of these therapies in men with advanced hormone-sensitive prostate cancer are not well-understood. Our study utilized clinical information and health insurance data to examine the treatments and healthcare costs for 871 men with advanced hormone-sensitive prostate cancer who received drug treatment between 2017–2021 in the United States. After diagnosis of advanced hormone-sensitive prostate cancer, over half of the men received only ADT without any advanced therapies. Before their disease advanced, patients with early-stage prostate cancer had $2,550 in monthly healthcare costs, increasing to almost $7,000 after the disease became advanced but before starting treatment for this advanced stage. After patients began treatment, costs were ∼$6,000 monthly, with three-quarters of this cost being directly related to prostate cancer. These results emphasize the significant healthcare costs associated with advanced prostate cancer. They underline the importance of considering comprehensive treatment options to enhance patient outcomes and potentially reduce the economic impact of advanced prostate cancer.