Characterizing the real-world economic burden of metastatic castration-sensitive prostate cancer in the United States.

Aims: To describe healthcare resource utilization (HRU) and costs of patients with metastatic castration-sensitive prostate cancer (mCSPC).Methods: Linked data from Flatiron Metastatic PC Core Registry and Komodo's Healthcare Map were evaluated (01/2016-12/2021). Patients with chart-confirmed diagnoses for metastatic PC without confirmed castration resistance in Flatiron who initiated androgen deprivation therapy (ADT) monotherapy or advanced therapy for mCSPC in 2017 or later (index date) with a corresponding pharmacy or medical claim in Komodo Health were included. Advanced therapies considered were androgen-receptor signaling inhibitors, chemotherapies, estrogens, immunotherapies, poly ADP-ribose polymerase inhibitors, and radiopharmaceuticals. Patients with <12 months of continuous insurance eligibility before index were excluded. Per-patient-per-month (PPPM) all-cause and PC-related HRU and costs (medical and pharmacy; from a payer's perspective in 2022 $USD) were described in the 12-month baseline period and follow-up period (from the index date to castration resistance, end of continuous insurance eligibility, end of data availability, or death).Results: Of 871 patients included (mean age: 70.6 years), 52% initiated ADT monotherapy as their index treatment without documented advanced therapy use. During baseline, 31% of patients had a PC-related inpatient admission and 94% had a PC-related outpatient visit; mean all-cause costs were $2,551 PPPM and PC-related costs were $839 PPPM with $787 PPPM attributable to medical costs. Patients had a mean follow-up of 15 months, during which 38% had a PC-related inpatient admission and 98% had a PC-related outpatient visit; mean all-cause costs were $5,950 PPPM with PC-related total costs of $4,363 PPPM, including medical costs of $2,012 PPPM.Limitations: All analyses were descriptive; statistical testing was not performed. Treatment effectiveness and clinical outcomes were not assessed.Conclusion: This real-world study demonstrated a significant economic burden in mCSPC patients, and a propensity to use ADT monotherapy in clinical practice despite the availability and guideline recommendations of advanced life-prolonging therapies.

Journal of medical economics. 2024 Feb 29 [Epub ahead of print]

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

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