Docetaxel chemotherapy in metastatic castration-resistant prostate cancer: cost of care in Medicare and commercial populations

Abstract

Objective: To estimate the healthcare costs and characteristics of docetaxel chemotherapy episodes of care for men with metastatic castration-resistant prostate cancer (mCRPC).

Methods: This study used the Medicare 5% sample and MarketScan Commercial (2010–2013) claims data sets to identify men with mCRPC and initial episodes of docetaxel treatment. Docetaxel episodes included docetaxel claim costs from the first claim until 30 days after the last claim, with earlier termination for death, insurance disenrollment, or the end of a 24-month look-forward period from initial docetaxel index date. Docetaxel drug claim costs were adjusted for 2011 generic docetaxel introduction, while other costs were adjusted to 2015 values using the national average annual unit cost increase.

Results: This study identified 281 Medicare-insured and 155 commercially insured men, with 325 and 172 docetaxel episodes, respectively. The average number of cycles (unique docetaxel infusion days) per episode was 6.9 for Medicare and 6.3 for commercial cohorts. The average cost per episode was $28,792 for Medicare and $67,958 for commercial cohorts, with docetaxel drug costs contributing $2,588 and $13,169 per episode, respectively. The average cost per episode on docetaxel infusion days was $8,577 (30%) for Medicare and $28,412 (42%) for commercial. Non-docetaxel infusion day costs included $7,074 (25%) for infused or injected drugs for Medicare, $10,838 (16%) for commercial cohorts, and $6,875 (24%) and $9,324 (14%) for inpatient admissions, respectively.

Limitations: The applicability is only to the metastatic castration-resistance clinical setting, rather than the metastatic hormone-sensitive setting, and the lack of data on the cost effectiveness of different sequencing strategies of a range of systemic therapies including enzalutamide, abiraterone, radium-223, and taxane chemotherapy.

Conclusion: The majority of docetaxel episode costs in Medicare and commercial mCRPC populations were non-docetaxel drug costs. Future research should evaluate the total cost of care in mCPRC.

Keywords:

• Metastatic
• castration-resistant prostatic cancer
• docetaxel
• healthcare
• costs

Transparency

Declaration of funding

This study was funded by Astellas Pharma, Inc. and Medivation, Inc., which was acquired by Pfizer, Inc. in September 2016, the co-developers of enzalutamide.

Declaration of financial/other relationships

AA reports consulting/advisory for Bayer, Medivation, Janssen Biotech, and Tokai; speaker’s bureau for Dendreon and Sanofi-Aventis; research funding for institute from Astellas Pharma, Dendreon, Bayer, Pfizer, Novartis, Bristol-Myers Squibb, KangLaiTe, Medivation, Janssen Biotech, Gilead, and Active Biotech; travel/accommodations from National Comprehensive Cancer Network; patent or intellectual property interest for himself and his institution from Duke University, Circulating Tumor Cell Technology. JC reports honoraria from Astellas Pharma, Sanofi-Aventis, Baxter, and Boeringher Ingelheim. KF reports research funding from AbbVie, Astellas, Bayer, Boehringer Ingelhein, Celgene, Daiichi Sankyo, Genentech, Janssen, Merck, Novo Nordisk, Novartis, Pfizer, and Sanofi. KF and TS are employees of Milliman, which received research funding from the study sponsors. TS reports research funding from Astellas Pharma. SF reports research funding for institute from Astellas Pharma; stock ownership of Johnson and Johnson and Abbot; travel/accommodations from Astellas Pharma. JD reports stock ownership of Astellas Pharma, Inc.; travel/accommodations from Astellas Pharma. CB, BB, SF, and JD are employees of Astellas Pharma, Inc. MB was an employee of Medivation during the study period; reports stock ownership of Medivation; travel/accommodations from Medication, Inc. CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

Milliman provided the claim data analytics for the study. Editorial support, funded by both sponsor companies, was provided by Jane Beck at Complete HealthVizion.