Real-world economic burden of metastatic castration-resistant prostate cancer before and after first-line therapy initiation.

To describe healthcare costs of patients with metastatic castration-resistant prostate cancer (mCRPC) initiating first-line (1L) therapies from a US payer perspective.

Patients initiating a Flatiron oncologist-defined 1L mCRPC therapy (index date) on or after mCRPC diagnosis were identified from linked electronic medical records/claims data from the Flatiron Metastatic Prostate Cancer (PC) Core Registry and Komodo's Healthcare Map. Patients were excluded if they initiated a clinical trial drug in 1L, had <12 months of insurance eligibility prior to index, or no claims in Komodo's Healthcare Map for the Flatiron oncologist-defined index therapy. All-cause and PC-related total costs per-patient-per-month (PPPM), including costs for services and procedures from medical claims (i.e., medical costs) and costs from pharmacy claims (i.e., pharmacy costs), were described in the 12-month baseline period before 1L therapy initiation (including the baseline pre- and post- mCRPC progression periods) and during 1L therapy (follow-up).

Among 459 patients with mCRPC (mean age 70 years, 57% White, 16% Black, 45% commercially-insured, 43% Medicare Advantage-insured, and 12% Medicaid-insured), average baseline all-cause total costs (PPPM) were $4,576 ($4,166 pre-mCRPC progression, $8,278 post-mCRPC progression). Average baseline PC-related total costs were $2,935 ($2,537 pre-mCRPC progression, $6,661 post-mCRPC progression). During an average 1L duration of 8.5 months, mean total costs were $13,746 (all-cause) and $12,061 (PC-related) PPPM. The cost increase following 1L therapy initiation was driven by higher PC-related outpatient and pharmacy costs. PC-related medical costs PPPM increased from $1,504 during baseline to $5,585 following 1L mCRPC therapy initiation.

All analyses were descriptive; statistical testing was not performed.

Incremental costs of progression to mCRPC are significant, with the majority of costs driven by higher PC-related costs. Using contemporary data, this study highlights the importance of utilizing effective therapies that slow progression and reduce healthcare resource demands despite the initial investment in treatment costs.

Journal of medical economics. 2024 Jan 11 [Epub ahead of print]

Deborah R Kaye, Ibrahim Khilfeh, Erik Muser, Laura Morrison, Frederic Kinkead, Ana Urosevic, Patrick Lefebvre, Dominic Pilon, Daniel J George

Duke University Cancer Center, Durham, NC, USA., Janssen Scientific Affairs, LLC, Horsham, PA, USA., Analysis Group, Inc., Montréal, QC, Canada.