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

Abstract

Aims

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

Methods

Patients initiating a Flatiron oncologist-defined 1 L 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 1 L, 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 1 L therapy initiation (including the baseline pre- and post- mCRPC progression periods) and during 1 L therapy (follow-up).

Results

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 1 L duration of 8.5 months, mean total costs were $13,746 (all-cause) and $12,061 (PC-related) PPPM. The cost increase following 1 L 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 1 L mCRPC therapy initiation.

Limitations

All analyses were descriptive; statistical testing was not performed.

Conclusion

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.

PLAIN LANGUAGE SUMMARY

Prostate cancer is one of the most common causes of cancer death in men. While outcomes are good if treated early, some patients may develop advanced disease that is more difficult and costly to treat. The most advanced form is late-stage hormone-resistant prostate cancer. Previous studies found that healthcare costs and use of medical services increase when prostate cancer advances to this stage. New medications are available, but their costs are not well known. Our study reviewed clinical information and health insurance data to estimate the healthcare costs and medical services used by 459 men who received drug treatment for late-stage hormone-resistant prostate cancer between 2017 and 2021 in the United States. In the year before a diagnosis and the start of drug treatment for late-stage hormone-resistant prostate cancer, total healthcare costs per month were approximately $4,000. After diagnosis of but before drug treatment for late-stage hormone-resistant prostate cancer, monthly healthcare costs nearly doubled, to approximately $8,000. Most of the additional $4,000 were specifically related to prostate cancer. After the start of the first drug treatment, total healthcare costs increased to approximately $13,500 every month. Most of the costs were related to medical office/clinic visits and medications. As their disease progressed, men received additional therapies, and office/clinic visits and use of chemotherapy also increased. These results emphasize the high healthcare costs and large number of medical services used by men with late-stage hormone-resistant prostate cancer. Therapies that slow progression to advanced prostate cancer may help to reduce high healthcare costs.

Keywords:

• Disease progression
• healthcare resource utilization
• metastatic castration-resistant prostate cancer
• metastatic hormone-resistant prostate cancer
• total cost of care

JEL Classification Codes:

• I10
• I11

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Addendum

Transparency

Declaration of funding

This study was funded by Janssen Scientific Affairs, LLC.

Declaration of financial/other relationships

DRK is an assistant professor at Duke University School of Medicine and reports the following in the past 24 months: Janssen Scientific Affairs, LLC (consultancy). IK is an employee of Janssen Scientific Affairs, LLC and stockholder of Johnson & Johnson. At the time of this study, EM was an employee of Janssen Scientific Affairs, LLC and stockholder of Johnson & Johnson. LM, FK, AU, PL, and DP are employees of Analysis Group, Inc., a consulting company that has provided paid consulting services to Janssen Scientific Affairs, LLC, which funded the development and conduct of this study and manuscript. DJG is a professor at Duke University School of Medicine and reports the following in the past 24 months: has acted in leadership role for Capio Biosciences; has acted as a paid consultant for and/or as a member of the advisory boards of Bayer, Exelixis, Pfizer, Sanofi, Astellas Pharma, Innocrin Pharma, Bristol Myers Squibb, Genentech, Janssen, Merck Sharp & Dohme, Myovant Sciences, AstraZeneca, Michael J. Hennessy Associates, Constellation Pharmaceuticals, Physicians’ Education Resource, Propella Therapeutics, RevHealth, and xCures; has been a member of the speakers’ bureau of Sanofi, Bayer, and Exelixis; has received honoraria from Sanofi, Bayer, Exelixis, EMD Serono, OncLive, Pfizer, UroToday, Acceleron Pharma, American Association for Cancer Research, Axess Oncology, Janssen Oncology, and Millennium Medical Publishing; has received research funding from Exelixis, Janssen Oncology, Novartis, Pfizer, Astellas Pharma, Bristol Myers Squibb, Acerta Pharma, Bayer, Dendreon, Innocrin Pharma, Calithera Biosciences, and Sanofi/Aventis; and has received other research support (travel, accommodations, expenses) from Bayer, Exelixis, Merck, Pfizer, Sanofi, Janssen Oncology, and UroToday.

Author contributions

LM, FK, AU, PL, and DP contributed to study conception and design, collection and assembly of data, and data analysis and interpretation. DRK, IK, EM, and DJG contributed to study conception and design, data analysis and interpretation. All authors reviewed and approved the final content of this manuscript.

Acknowledgements

Medical writing assistance was provided by Jill Korsiak, PhD, and Loraine Georgy, PhD, MWC, employees of Analysis Group, Inc., a consulting company that has provided paid consulting services to Janssen Scientific Affairs, LLC., which funded the development and conduct of this study and manuscript.

Data availability statement

Data that support the findings of this study were used under license from Flatiron Health, Inc. and Komodo Health Solutions. Restrictions apply to the availability of these data, which are not publicly available and cannot be shared. The data are available through request made directly to the data vendor, subject to the data vendor’s requirements for data access.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Previous presentations

Part of the material in this manuscript was presented at the International Society for Pharmacoeconomics and Outcomes Annual Meeting from May 7-10, 2023 in Boston, MA, USA.

Data transparency

The authors declare that the data supporting the findings of this study are available within the article and its supplemental information files.