Clinical characteristics, treatment pattern, and medical costs associated with metastatic castration-resistant prostate cancer in Chinese tertiary care hospital settings

Figures & data

Figure 1. Flow chart of identifying eligible patients with mCRPC.

Table 1. Summary of patient baseline characteristics of the included mCRPC patients.

Patient characteristics	Sample size	Mean ± SD/n	Median/%	Q1–Q3	Patient characteristics	Sample size	Mean ± SD/n	Median/%	Q1–Q3
Demographics					Laboratory tests
Age (years)	78	70.7 ± 9.9	70.8	63.4–79.1	Total PSA (ng/ml)	78	76.9 ± 194.1	29.2	9.5–84.7
Residence location					Testosterone (ng/dl)	45	7.9 ± 11.9	2.5	0.2–13.1
Changsha	78	31	39.7%		Complications
Medium-sized city	78	19	24.4%		Any complications	78	9	11.5%
County	78	16	20.5%		Bone pathological facture	78	4	5.1%
Village	78	12	15.4%		Renal dysfunction	78	3	3.9%
Insurance plan					Bone pain	78	2	2.6%
Public insurance	64	52	81.3%		Infection	78	1	1.3%
Out-of-pocket	64	11	17.2%		Anemia	78	1	1.3%
Commercial insurance	64	1	1.6%		Others	78	1	1.3%
Prostate cancer stage					Comorbidities
I	72	2	2.8%		Vascular diseases	78	16	20.5%
II	72	14	19.4%		Digestive diseases	78	10	12.8%
III	72	2	2.8%		Endocrine disease	78	9	11.5%
IV	72	54	75.0%		Previous treatment
Site of metastasis					Prostate cancer radical surgery	78	6	7.7%
Bone	78	71	91.0%		Orchiectomy	78	18	23.1%
Lymphatic system	78	20	25.6%		Hormone therapy	78	58	74.4%
Urogenital system	78	16	20.5%		Combination of hormone therapy and chemotherapy	78	2	2.6%
Respiratory system	78	9	11.5%		Radiation therapy	78	12	15.4%
Digestive system	78	6	7.7%		Chemotherapy	78	18	23.1%
Time to mCRPC from the diagnosis of prostate cancer (years)	78	2.0 ± 2.0	1.4	0.8–2.2	Best supportive care	78	4	5.1%

Table 2. Summary of the treatment patterns associated with treatment episodes after the diagnosis of mCRPC.

Sequence of treatment episode	First treatment episode	Second treatment episode	Third treatment episode
Sample size	70	19	3
Androgen receptor antagonist + LHRH	54.3%	15.8%	0.0%
Androgen receptor antagonist	30.0%	31.6%	0.0%
LHRH	12.9%	10.5%	0.0%
Chemotherapy	11.4%	21.1%	33.3%
Estrogen	8.6%	0.0%	33.3%
Estrogen + Androgen receptor antagonist	5.7%	0.0%	0.0%
Best supportive care	5.7%	21.1%	0.0%
Androgen receptor antagonist + LHRH + Chemotherapy	5.7%	10.5%	33.3%
Androgen receptor antagonist + Chemotherapy	4.3%	42.1%	0.0%
Estrogen + LHRH	4.3%	5.3%	0.0%
Estrogen + LHRH + Androgen receptor antagonist	4.3%	0.0%	0.0%
Steroidal CYP17A1 inhibitor + LHRH + Androgen receptor antagonist	2.9%	0.0%	0.0%
LHRH + Chemotherapy	2.9%	5.3%	0.0%
Steroidal CYP17A1 inhibitor	1.4%	21.1%	0.0%
LHRH Steroidal CYP17A1 inhibitor	1.4%	15.8%	33.3%
Estrogen + Chemotherapy	1.4%	0.0%	0.0%
Steroidal CYP17A1 inhibitor + Chemotherapy	0.0%	0.0%	33.3%

Figure 2. Multiple logistic regression analysis exploring the predictors for chemotherapy in the included mCRPC patients.

Table 3. Summary of health resources utilization and medical costs associated with mCRPC treatments in the first treatment episode.

Treatment type	Hormone therapy			Chemotherapy			Best supportive care			p value*
Sample size	53			15			2
Variables	Mean ± SD	Median	Q1–Q3	Mean ± SD	Median	Q1–Q3	Mean ± SD	Median	Q1–Q3
Treatment duration (months)	6.8 ± 6.2	5.9	1.4–9.3	5.6 ± 6.3	3.1	1.8–6.4	1.4 ± 1.9	1.4	0.7–2.1	0.415
Health resources utilization
Hospital admissions	3 ± 2	2	1–3	4 ± 3	3	2–4			0–0	0.308
Hospital stay days	28 ± 46	11	6–34	22 ± 19	16	11–23			0–0	0.634
Outpatient clinic visits	4 ± 3	2	1–6	3 ± 4	1	1–5	2 ± 1	2	2–3	0.722
Monthly medical costs
Drugs associated hospitalization	¥4,727 ± ¥6,692	¥4,188	¥1,610–¥7,804	¥7,856±¥7,832	¥6,298	¥2,289–¥7,938			¥0–¥0	0.019
Non-drug care associated with hospitalization	¥3,455 ± ¥4,911	¥2,160	¥1,337–¥5,755	¥7,412±¥5,658	¥5,218	¥3,751–¥9,838			¥0–¥0	0.001
Drugs associated with outpatient clinic visits	¥1,571 ± ¥7,565	¥1,743	¥1,308–¥2,572	¥62±¥181	¥148	¥113–¥424	¥130 ± ¥115	¥130	¥49–¥212	0.174
Non-drug care associated with outpatient clinic visits	¥20 ± ¥50	¥58	¥30–¥155	¥1±¥4	¥15	¥15–¥15			¥0–¥0	0.259
All drugs	¥6,298 ± ¥9,345	¥3,255	¥1,692–¥6,592	¥7,918±¥7,777	¥6,298	¥2,289–¥7,938	¥130 ± ¥115	¥130	¥49–¥212	0.028
All non-drug care	¥3,475 ± ¥4,898	¥1,693	¥397–¥4,056	¥7,413±¥5,657	¥5,218	¥3,751–¥9,838			¥0–¥0	0.001
All costs	¥9,772 ± ¥12,521	¥5,173	¥2,496–¥11,352	¥15,331±¥10,776	¥12,151	¥7,541–¥21,326	¥130 ± ¥115	¥130	¥49–¥212	0.002

*p-value was for the comparisons between hormone therapy and chemotherapy.

Italics indicate statistical significance that was defined as p-value less than 0.05.

Table 4. Results of multivariate generalized linear regression analysis exploring the predictors for drug costs, non-drug costs, and total costs per month in the first treatment episode.

Type of costs per month		Drug costs				Non-drug costs				All medical costs
Variable	Reference	Coefficient	95% CI		p-value	Coefficient	95% CI		p-value	Coefficient	95% CI		p-value
			Lower	Upper			Lower	Upper			Lower	Upper
Cost index year
2013	2012	0.724	−0.268	1.717	0.153	−0.040	−1.412	1.332	0.955	0.459	−0.496	1.413	0.347
2014	2012	0.359	−0.510	1.227	0.418	1.093	−0.150	2.337	0.085	0.648	−0.194	1.491	0.131
2015	2012	0.357	−0.511	1.225	0.420	0.845	−0.362	2.051	0.170	0.531	−0.302	1.364	0.211
2016	2012	−0.022	−0.878	0.834	0.960	0.159	−1.028	1.345	0.793	0.062	−0.759	0.883	0.882
Tumor stage III at diagnosis of prostate cancer	Stage IV	−1.800	−2.932	−0.669	0.002	−3.708	−5.515	−1.900	<0.001	−2.139	−3.249	−1.028	<0.001
Time to mCRPC (years)		−0.087	−0.180	0.006	0.067	0.029	−0.120	0.177	0.702	−0.045	−0.140	0.049	0.350
Total PSA (ng/ml)		0.001	0.000	0.003	0.075	0.001	0.000	0.003	0.143	0.001	0.000	0.003	0.093
Infection at diagnosis of mCRPC		−3.756	−5.503	−2.008	<0.001	−0.516	−3.034	2.003	0.688	−2.131	−3.822	−0.440	0.014
Anemia at diagnosis of mCRPC		−2.510	−4.078	−0.943	0.002	−4.232	−6.417	−2.047	<0.001	−2.854	−4.363	−1.345	<0.001
Urological diseases		1.699	0.773	2.624	<0.001	0.838	−0.488	2.164	0.215	1.530	0.642	2.418	0.001
Chemotherapy for mCRPC	Hormone therapy	0.021	−0.468	0.511	0.932	0.463	−0.205	1.131	0.174	0.326	−0.136	0.788	0.166

Italics indicate statistical significance that was defined as p-value less than 0.05.