Health Care Costs in Patients with Metastatic Castration-Resistant Prostate Cancer

Citing a need for data on the cost of metastatic castration-resistant prostate cancer (mCRPC) treatment particularly as the number of available treatment options increases researchers performed an analysis on U.S. administrative claims data. In their study, presented at AMCP 2022 by lead author, E. Malangone-Monaco, the investigators estimated that the average all-cause costs per-patient-per-month (PPPM) were $17,417 during follow-up.

Additionally, the authors observed that antiandrogens were the most utilized antineoplastic, although 55% of patients had received other treatment lines as well as antineoplastics. Overall, these patients “tended to experience multiple therapeutic inventions as well as ER and hospitalizations,” a characterization that was not surprising given the “severity of standing, Gleason scores, and death rates,” in the claims dataset.

The study utilized the IBM MarketScan Commercial and Medicare Supplemental databases to enroll men with a diagnosis of prostate cancer (PC) with evidence for subsequent metastasis and castration. The incident mCRPC status, used as the index point, was determined by a treatment algorithm “based on use of novel hormonal therapies (NHT) and FDA approved mCRPC therapies in consultation with clinical experts.” All-cause health care costs were assessed for a 12-month pre-mCRPC baseline period, during lines of therapy (LOT), and for at least one month of post-mCRPC follow-up. The costs of clinical events of interest (CEIs) were measured 30 days prior to and 30 days after the first recorded CEI during follow-up.

In a total of 2,912 mCRPC patients, aged a mean 71 ± 10 at indexing and followed for 16 ± 12.5 months, the most common index treatments were monotherapies with abiraterone (35%), enzalutamide (34%), and docetaxel (14%). Patients who received docetaxel at indexing were younger than patients who received index NHT (p <0.001). The largest minority group during follow-up was African Americans at 42.8%. The staging of 933 patients showed that 57.6^ had localized diagnosis, 20.9% had distant sites, and 9.9% had regional involvement with direct extension. Gleason levels were “relatively high,” with 620 patients having a score above six. Additional treatments included radiation (n = 384), surgery (n = 228), or both (n = 47). Hospitalizations among 206 patients revealed a mean of 1.6 events and a 2.4-day duration of stay. Similarly, ER visits in 364 cases revealed a mean of 2.4 ER events.

Overall, the authors advanced their data as evidence of the high cost of mCRPC, with additional characterization of common therapies and health care resource utilization. In closing, they proposed that “combining registry, hospital, and pharmacy data sources can identify practical insights to improving oncology care,” and ultimately recommended that “pharmacy programs managing oncology patients should include screening for risk factors associated with adverse outcomes to help manage cancer care.”