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

Abstract

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 $2551 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 $5950 PPPM with PC-related total costs of $4363 PPPM, including medical costs of $2012 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.

PLAIN LANGUAGE SUMMARY

Prostate cancer is one of the most common causes of male cancer death. Almost 1/10 men who are diagnosed early develop advanced disease. Androgen deprivation therapy (ADT), which reduces male hormone levels to slow prostate cancer growth, is part of the standard care for early-stage and advanced/metastatic hormone-sensitive prostate cancer. This form of cancer still responds to hormonal treatment. Recently, new advanced therapies targeting cancer in different ways than ADT and offering benefits in survival and disease progression have become available and are associated with improved survival compared to treatment with only ADT. However, the usage and costs of these therapies in men with advanced hormone-sensitive prostate cancer are not well-understood. Our study utilized clinical information and health insurance data to examine the treatments and healthcare costs for 871 men with advanced hormone-sensitive prostate cancer who received drug treatment between 2017–2021 in the United States. After diagnosis of advanced hormone-sensitive prostate cancer, over half of the men received only ADT without any advanced therapies. Before their disease advanced, patients with early-stage prostate cancer had $2,550 in monthly healthcare costs, increasing to almost $7,000 after the disease became advanced but before starting treatment for this advanced stage. After patients began treatment, costs were ∼$6,000 monthly, with three-quarters of this cost being directly related to prostate cancer. These results emphasize the significant healthcare costs associated with advanced prostate cancer. They underline the importance of considering comprehensive treatment options to enhance patient outcomes and potentially reduce the economic impact of advanced prostate cancer.

Keywords:

• Healthcare resource utilization
• metastatic castration-sensitive prostate cancer
• real-world evidence
• total cost of care
• patient stratification
• electronic medical records
• medical and prescription claims

JEL Classification Codes:

• I10
• I11

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Addendum

Transparency

Declaration of financial interests

DRK is an assistant professor at Duke University School of Medicine and reports the following in the past 24 months: Janssen Scientific Affairs, LLC, a Johnson & Johnson company (consultancy). IK is an employee of Janssen Scientific Affairs, LLC, a Johnson & Johnson company and stockholder of Johnson & Johnson. At the time of this study, EM was an employee of Janssen Scientific Affairs, LLC, a Johnson & Johnson company and stockholder of Johnson & Johnson. LM, FK, PL, and DP are employees of Analysis Group, Inc., a consulting company that has provided paid consulting services to Janssen Scientific Affairs, LLC, a Johnson & Johnson company, 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 a 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, 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 Loraine Georgy, PhD, MWC, an employee of Analysis Group, Inc., a consulting company that has provided paid consulting services to Janssen Scientific Affairs, LLC, a Johnson & Johnson company, 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 statement

Peer reviewers on this manuscript have received an honorarium from JME for their review work but have no other relevant financial relationships to disclose.

Previous presentations

Part of the material in this manuscript was presented at the Annual American Society of Clinical Oncology Genitourinary Cancers Symposium held January 25-27, 2024 in San Francisco, CA as a poster presentation.

Data transparency

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

Additional information

Funding

This study was funded by Janssen Scientific Affairs, LLC, a Johnson & Johnson company.