AUA 2022: Comparative Out-of-Pocket Costs of Treatment Options in Privately Insured Patients with Advanced Prostate Cancer

( In a moderated poster presentation at the 2022 American Urologic Association Annual Meeting held in New Orleans and virtually, Dr. Joyce presented data examining out-of-pocket costs for privately insured patients receiving treatment for advanced prostate cancer. While financial toxicity is a significant burden for many patients with cancer, this is relatively understudied in patients with advanced prostate cancer.

The authors used the OptumLabs claims dataset to identify all privately insured men with available out-of-pocket costs receiving systemic therapy for advanced prostate cancer (biochemical recurrent or metastatic) from 2007-2019. The authors specifically looked at three different treatment approaches androgen deprivation (ADT) monotherapy (i.e. leuprolide/degarelix); novel hormonal (abiraterone, enzalutamide, apalutamide, darolutamide); non-hormonal (chemotherapy, immunotherapy). Stratified by the treatment approach, the authors examined the primary outcome of out-of-pocket costs in the first year of treatment. They further used Group multivariable regressions with generalized linear models with gamma distributions to calculate adjusted differences in out-of-pocket costs. All costs were adjusted to reflect 2019 U.S. dollars using the consumer price index.

Among 13,661 men identified in their dataset meeting inclusion criteria, 80% (n=10,926) received ADT monotherapy, 8% (n=1,084) received novel hormonal treatments, and 12% (n=1,651) received non-hormonal treatments. Perhaps not surprising, mean out-of-pocket-costs in the first year of treatment were lowest in patients receiving ADT monotherapy ($2,828) as compared to novel hormonal ($6,882) and non-hormonal treatments ($5,191).


On multivariable analysis, novel hormonal (coeff: 1.99, p<0.001) and non-hormonal (coeff: 1.70, p<0.001) treatments were associated with increased total out-of-pocket-costs in the first year of treatment compared to ADT monotherapy. Patient factors associated (p<0.001) with higher out-of-pocket-costs included older age, Asian/Hispanic race/ethnicity, and comorbidity.

Thus, Dr. Joyce concluded that, for privately insured patients with advanced prostate cancer, treatment with novel hormonal agents was associated with substantially higher out-of-pocket-costs than other therapies. In addition to raising awareness among prescribers, these data support the inclusion of financial toxicity discussions as a part of patient counseling for these agents.

Presented by: Daniel Joyce, MD, Mayo Clinic, Rochester, MN

Written by: Christopher J.D. Wallis, University of Toronto, Twitter: @WallisCJD during the 2022 American Urological Association (AUA) Annual Meeting, New Orleans, LA, Fri, May 13 – Mon, May 16, 2022.



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