Economic burden and healthcare utilization associated with castration-resistant prostate cancer in a commercial and Medicare Advantage US patient population

Figures & data

Figure 1. Patient identification. PSA, prostrate-specific antigen; CRPC, castration-resistant prostate cancer.

Table 1.  Patient demographics.

	Total (n = 2740)		Known CRPC (n = 349)		Likely CRPC (n = 2391)		p-value
Age (mean, SD)	72.88	9.85	68.23	9.68	73.56	9.69	<0.0001
Age group (n, %)
40–54	92	3.36	22	6.30	70	2.93	0.0011
55–64	564	20.58	119	34.10	445	18.61	<0.0001
65–74	771	28.14	111	31.81	660	27.60	0.1030
75+	1313	47.92	97	27.79	1216	50.86	<0.0001
Insurance type (n, %)
Commercial	1496	54.60	213	61.03	1283	53.66	0.0098
Medicare Advantage	1244	45.40	136	38.97	1108	46.34	0.0098
Health plan region (n, %)
Northeast	269	9.82	53	15.19	216	9.03	0.0003
Midwest	1115	40.69	88	25.21	1027	42.95	<0.0001
South	1170	42.70	204	58.45	966	40.40	<0.0001
West	186	6.79	4	1.15	182	7.61	<0.0001

CRPC, castration-resistant prostate cancer; SD, standard deviation.

Table 2.  Patient clinical characteristics.

	Total (n = 2740)		Known CRPC (n = 349)		Likely CRPC (n = 2391)		p-value
Type of castration	n	%	n	%	n	%
Surgical	114	4.16	14	4.01	100	4.18	0.8813
Medical	2626	95.84	335	95.99	2291	95.82	0.8813
Docetaxel use following castration	676	24.67	87	24.93	589	24.63	0.9052
Bone scan following castration	2545	92.88	293	83.95	2252	94.19	<0.0001
Oncology visit following castration	1395	50.91	196	56.16	1199	50.15	0.0358
Urology visit following castration	2432	88.76	308	88.25	2124	88.83	0.7482
	Mean	SD	Mean	SD	Mean	SD
Time from castration to index date (days)	719.72	510.43	664.47	414.41	727.78	522.56	0.0104
Time from index date to end of post-index period (days)	406.46	364.13	593.23	420.77	379.19	346.89	<0.0001

CRPC, castration-resistant prostate cancer; SD, standard deviation.

Table 3.  Post-index prostate cancer-related and all-cause healthcare utilization.

	Total (n = 2740)		Known CRPC (n = 349)		Likely CRPC (n = 2391)		p-value
All-cause healthcare utilization	Incidence*		Incidence		Incidence
Inpatient stay	0.048		0.031		0.052		<0.0001
ER visit	0.061		0.036		0.067		<0.0001
Ambulatory visit	4.659		2.135		5.639		<0.0001
	Mean	SD	Mean	SD	Mean	SD
PPPM count of inpatient stays	0.10	0.18	0.08	0.15	0.11	0.19	0.0019
PPPM count of ER visits	0.16	0.31	0.11	0.24	0.16	0.32	0.0001
PPPM count of ambulatory visits	3.34	2.61	2.98	2.43	3.39	2.63	0.0052
Prostate cancer-related healthcare utilization	Incidence		Incidence		Incidence
Inpatient stay	0.018		0.017		0.018		0.5526
ER visit	0.003		0.003		0.003		0.8736
Ambulatory visit	0.603		0.568		0.609		0.2304
	Mean	SD	Mean	SD	Mean	SD
PPPM count of inpatient stays	0.04	0.12	0.05	0.11	0.04	0.12	0.5549
PPPM count of ER visits	0.01	0.08	0.02	0.12	0.01	0.07	0.2820
PPPM count of ambulatory visits	1.43	1.69	1.40	1.57	1.44	1.71	0.6875

*Incidence per person-month.

PPPM, per-patient per-month; CRPC, castration-resistant prostate cancer; SD, standard deviation.

Table 4.  Post-index prostate cancer-related and all-cause care costs (per-patient per-month).

	Total (n = 2740)		Known CRPC (n = 349)		Likely CRPC (n = 2391)		p-value
	Mean (SD)	Median (IQR)	Mean (SD)	Median (IQR)	Mean (SD)	Median (IQR)
All-cause healthcare costs
Total costs	$3507 (5540)	$1560 (635–4336)	$3734 (4969)	$1807 (637–4907)	$3474 (5618)	$1537 (634–4241)	0.2214
Medical costs	$3212 (5441)	$1242 (450–3991)	$3388 (4767)	$1430 (449–4554)	$3186 (5533)	$1205 (450–3902)	0.1630
Pharmacy costs	$295 (475)	$168 (45–382)	$346 (812)	$169 (53–384)	$288 (402)	$168 (43–382)	0.5329
Inpatient costs	$1208 (4177)	$0 (0–736)	$1138 (2991)	$0 (0–944)	$1219 (4324)	$0 (0–713)	0.6470
ER costs	$57 (197)	$1 (0–40)	$32 (77)	$0 (0–32)	$61 (208)	$1 (0–41)	0.1947
Ambulatory costs	$1851 (2813)	$694 (239–2093)	$2113 (3102)	$909 (324–2704)	$1813 (2767)	$668 (232–1993)	0.0017
Other medical costs	$96 (261)	$21 (3–82)	$106 (261)	$31 (13–89)	$94 (261)	$20 (2–80)	<0.0001
Prostate cancer-related healthcare costs
Total costs	$1799 (3505)	$474 (61–1778)	$2247 (3978)	$739 (164–2630)	$1734 (3427)	$445 (52–1634)	<0.0001
Medical costs	$1728 (3464)	$417 (46–1653)	$2145 (3913)	$687 (139–2559)	$1667 (3390)	$390 (39–1529)	<0.0001
Pharmacy costs	$72 (229)	$0 (0–31)	$102 (357)	$1 (0–62)	$67 (204)	$0 (0–25)	<0.0001
Inpatient costs	$559 (2383)	$0 (0–0)	$752 (2811)	$0 (0–243)	$531 (2313)	$0 (0–0)	<0.0001
ER costs	$1 (14)	$0 (0–0)	$1 (4)	$0 (0–0)	$1 (15)	$0 (0–0)	0.3088
Ambulatory costs	$1152 (2073)	$328 (32–1191)	$1363 (2379)	$514 (118–1739)	$1122 (2023)	$303 (28–1108)	<0.0001
Other medical costs	$15 (80)	$1 (0–9)	$29 (87)	$8 (4–22)	$13 (79)	$0 (0–6)	<0.0001

SD, standard deviation; CRPC, castration-resistant prostate cancer; IRQ, interquartile range.

Table 5.  Pre-index prostate cancer-related healthcare costs (per-patient per-month).

Prostate cancer-related healthcare costs	Total (n = 2740)		Known CRPC (n = 349)		Likely CRPC (n = 2391)		p-value
	Mean (SD)	Median (IQR)	Mean (SD)	Median (IQR)	Mean (SD)	Median (IQR)
Total costs	$750 (1244)	$352 (49–894)	$1103 (2005)	$436 (37–1127)	$699 (1080)	$338 (51–879)	0.1620
Medical costs	$679 (1170)	$288 (35–790)	$1001 (1836)	$422 (24–959)	$633 (1030)	$277 (39–758)	0.1571
Pharmacy costs	$71 (233)	$0 (0–33)	$103 (474)	$0 (0–47)	$66 (171)	$0 (0–30)	0.0644
Inpatient costs	$102 (560)	$0 (0–0)	$142 (943)	$0 (0–0)	$96 (480)	$0 (0–0)	0.1212
ER costs	$1 (17)	$0 (0–0)	$0 (6)	$0 (0–0)	$1 (18)	$0 (0–0)	0.3133
Ambulatory costs	$567 (948)	$259 (29–688)	$843 (1469)	$400 (16–876)	$527 (839)	$242 (31–649)	0.1560
Other medical costs	$9 (34)	$0 (0–6)	$15 (29)	$7 (3–15)	$9 (34)	$0 (0–5)	<0.0001

CRPC, castration-resistant prostate cancer; IQR, interquartile range; SD, standard deviation.

Table A1.  NDC codes used to identify medical castration in the pharmacy claims.

Medication	NDC codes
Leuprolide	00024022205, 00024059707, 00024059722, 00024060545, 00024061030, 00024079375, 00024079379, 00026971101, 00074210803, 00074228203, 00074244003, 00074334603, 00074364103, 00074364203, 00074366303, 00074368303, 00182315499, 00185740014, 00185740085, 00300210601, 00300210801, 00300227001, 00300228201, 00300243701, 00300244001, 00300333601, 00300334301, 00300334601, 00300361224, 00300361228, 00300362001, 00300362624, 00300362628, 00300362901, 00300362906, 00300363901, 00300363906, 00300364101, 00300364201, 00300366301, 00300367301, 00300368301, 00406805003, 00703401411, 00703401418, 00703401419, 00703402419, 41616093640, 49884036826, 54569264700, 54569271300, 54569344400, 54569452600, 54569454700, 54569478500, 54569498200, 54569526200, 54868282500, 54868327700, 54868556800, 55390051505
Triptorelin	00009521501, 00009521601, 00009521901, 00009766401, 52544015302, 52544015376, 52544015402, 52544015476, 52544018876, 52544018976
Goserelin	00310095036, 00310095130, 00310096036, 00310096130, 54569394300
Histrelin	54092063775, 54092063875, 54092063975, 55592050001, 67979000201, 67979050001

NDC, National Drug Code.

Table A2.  Days supply associated with one billed unit for HCPCS for medical castration.

Code	Description	Days supply associated with one unit
J1950	Injection, leuprolide acetate (for depot suspension), per 3.75 mg	14 days
J9217	Leuprolide acetate (for depot suspension), 7.5 mg	28 days
J9218	Leuprolide acetate, per 1 mg	1 day
J9219	Leuprolide acetate implant, 65 mg	365 days
Q0057	Leuprolide acetate for depot suspension, 7.5 mg	28 days
J3315	Injection, triptorelin pamoate, 3.75 mg	28 days
J9202	Goserelin acetate implant, per 3.6 mg	28 days
J9225	Histrelin implant (Vantas), 50 mg	365 days
J9226	Histrelin implant (Supprelin LA), 50 mg	365 days
S0133	Histrelin, implant, 50 mg	365 days

HCPCS, Healthcare Common Procedure Coding System.