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Health Care Resource Utilization and Costs Associated With Disease Progression Among Patients With Metastatic Castration-Sensitive Prostate Cancer
In patients with nonmetastatic castration-sensitive prostate cancer (nmCSPC), survival rates decrease when the tumor becomes castration-resistant or metastasizes. Metastasis also increases health care costs considerably, although the data available to quantify this increase are limited.
To determine the health care resource utilization and costs of progression to metastatic disease in patients with nmCSPC or previously undiagnosed prostate cancer that was metastatic at diagnosis (de novo), researchers conducted a retrospective, observational cohort study by using claims-based data from the IBM MarketScan Medicare Supplemental and MarketScan Commercial Databases (J Manag Care Spec Pharm. 2022;28(5):544-554. doi:10.18553/jmcp.2022.28.5.544). Their study revealed that direct all-cause health care costs in patients with nmCSPC increased between two- and four-fold after metastasis and that these increases appeared several months before diagnosis of metastatic disease.
“Development of metastatic CSPC is associated with considerable costs over a 24-month follow-up period,” wrote Quoc-Dien Trinh, MD, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, and colleagues. “Cost increases are greater for de novo patients than for those who progressed from localized disease.”
The study enrolled adult patients aged ≥18 years, had two or more health care claims associated with a diagnosis of prostate cancer, and had a diagnosis of metastatic disease between 2014 and 2016. Using these criteria, the researchers enrolled 3854 patients, including 2766 Medicare patients and 1088 commercially insured patients. Mean age was 78.8 years (+ 7.6 yr) in the Medicare group and 57.6 years (+ 4.3 yr) in the commercially insured group. Patients with a de novo diagnosis of metastatic disease accounted for 29% of Medicare patients and 35% of commercially insured patients.
The researchers summarized unadjusted all-cause direct health care costs during the 2 years before diagnosis of metastatic disease and up to 2 years after that diagnosis. They then estimated metastasis-related incremental all-cause direct health care costs by using regression modeling to adjust for baseline characteristics of patients, duration of follow-up, and any selection bias.
As a result, they determined that, among those in whom prostate cancer progressed to metastatic disease, the mean unadjusted total all-cause health care costs during the 2 years before diagnosis of metastatic disease were $52,661 for Medicare patients and $43,111 for commercially insured patients. For patients with a de novo diagnosis of metastatic disease, these costs were $39,756 for Medicare patients and $22,090 for commercially insured patients.
Mean unadjusted health care costs after a diagnosis of metastatic disease were $100,331 for Medicare patients during a mean follow-up of 14.6 months and $127,374 for commercially insured patients during a mean follow-up of 18.4 months. For patients with a de novo diagnosis of metastatic disease, these costs were $124,538 for Medicare patients during a mean follow-up of 14.1 months and $173,408 for commercially insured patients during a mean follow-up of 17.3 months.
After adjustment, when the researchers assumed that data were available for the 2 years after diagnosis of metastatic disease, estimated incremental cost increases resulting from progression in patients with prior CSPC were $104,051 for Medicare patients and $93,334 for commercially insured patients. For patients with a de novo diagnosis of metastatic disease, these cost increases were estimated to be $180,932 for Medicare patients and $215,397 for commercially insured patients.
