Comparing Costs and Health Care Resource Utilization Among Patients With Metastatic, Castration-Resistant vs Nonmetastatic Prostate Cancer

Overall annual out-of-pocket costs for patients with metastatic, hormone-sensitive prostate cancer (HSPC) were $1,044 greater than those for patients with nonmetastatic, HSPC, and overall annual payer costs were $113,725 greater, according to a retrospective cohort analysis of claims data (J Manag Care Spec Pharm. 2022; 28(3):287-295. doi:10.18553/jmcp.2022.28.3.287). 

The authors aimed “To estimate the differences in health care resource utilization (HCRU) and costs for patients with nonmetastatic HSPC (nmHSPC) and metastatic HSPC (mHSPC) and their payers,” wrote Gilbert Chao Ko, PharmD, MBA, MS, and colleagues in the Department of Pharmacy, University of Washington, Seattle, WA.

Although previous studies assessed the cost and HCRU differentials between these two types of HSPC, they did not determine differentials for patients with hormone-sensitive cancer, even though most prostate cancer is hormone-sensitive. Instead, studies have focused on the costs and HCRU for castration-resistant prostate cancer or prostate cancer in general. 

The study investigators analyzed data from IBM MarketScan databases from January 2016 to December 2019. They defined patients with HSPC as those who had a least 1 inpatient service or 2 outpatient service claims for androgen deprivation therapy within 6 months of their initial diagnostic claim. Such therapy consists of orchiectomy, a luteinizing hormone-releasing hormone (LHRH) agonist or antagonist, or an LHRH agonist plus a first-generation antiandrogen. It is the primary systemic therapy for regional or advanced HSPC and is the criterion standard initial therapy for metastatic HSPC. 

Patients with metastatic disease were identified by a secondary diagnosis code for metastasis accompanying their initial diagnostic claim. The investigators used multivariable linear regression to compare cost differentials between patients with metastatic and those with nonmetastatic disease.

The analysis, which included data for 4329 commercially insured or Medicare-supplement insured US patients, 600 of whom had metastatic disease, found that those with metastatic disease had nearly 11 more prescription fills and nearly 11 more outpatient service visits when compared with those with nonmetastatic disease. However, utilization of other health care resources was similar between patients with metastatic disease and those with nonmetastatic disease.

In addition, authors found that the differences in cost and HCRU between patients with metastatic disease and those with nonmetastatic disease were greater for patients less than 65 years old than for those aged ≥ 65 years who were eligible for Medicare. 

Findings from this study can be used to identify financial burdens to address in patient subgroups and to provide data for cost-effectiveness models that can determine the value of the many new treatments approved for metastatic HSPC. These treatments include the novel hormonal therapies apalutamide, abiraterone, and enzalutamide.

“Treatment for HSPC has advanced greatly in the past 2 decades, improving the treatment paradigm for patients. However, the growth of available treatment options for HSPC has driven an increase in its economic impact,” the study investigators noted.

“Future research may provide additional insight into benefits of delaying metastatic disease progression by using datasets more inclusive of Medicare and Medicaid populations,” they concluded.