Hupe Marie Christine, Hammerer Peter, Ketz Miriam, Kossack Nils, Colling Christiane, Merseburger Axel S
Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland.
Klinik für Urologie, Akademisches Lehrkrankenhaus Braunschweig, Braunschweig, Deutschland.
Aktuelle Urol. 2020 Jun;51(3):275-284. doi: 10.1055/a-1018-1651. Epub 2019 Nov 19.
Androgen deprivation therapy (ADT) plays a pivotal role in the treatment of advanced or metastasised prostate cancer (PCa). The aim of this health services research was to compare real-world data on the initial use of different GnRH agonists and antagonists (GnRHa) with regard to prescription patterns, hospitalisation rates and costs.
Anonymised claims data from > 70 German health insurance funds between 2010 and 2015 (n = 4 205 227) were analysed (1 year pre-observation period, 1 index quarter with initial GnRHa prescription, ≥ 2 years of follow-up (FU)).
The study population included 2382 PCa patients (mean age 75 years). Leuprolide (Leu) was prescribed most frequently (56.6 %). At initial GnRHa administration, 70 % of patients neither had lymph node nor distant metastases. Around 11.2 % of all patients stopped GnRHa treatment after the first prescription, 17.6 % switched their initial therapy to another substance after a mean of 457 days (median: 399 days); in the hybrid (hyb) group 100 days earlier on average than in the agonist group (p = 0.016). The prevalence ranking of the most common comorbidities was consistent over time: hypertension, hyperlipidaemia, cardiovascular disease (CVD) and diabetes. The prevalence of hypertension increased significantly in the agonist group (16.4 %) compared with the antagonist (6.9 %, p = 0.022) and hyb group (11.6 %, p = 0.006). With regard to CVD, there were no significant differences in the relative growth rate between the 3 combined therapy classes. In total, 23.9 % of all patients died within the 3-year FU. The mortality rate was lowest for triptorelin (Trp, 22.1 %) and highest for goserelin (Gos, 29.4 %, n.s.). In the index quarter, 26.4 % of patients had at least one inpatient hospitalisation [min-max: Trp 22.4 %; Gos 30.3 %], with an average length of hospital stay/patient of 3 days [Trp 2.4; Gos 4.5]. The annual hospitalisation rate was between 36.2 and 40.7 %, the average length of hospital stay in the entire FU was between 17.6 (Trp) and 20.8 days (hyb). The average hospital costs in the index quarter were approx. EUR 1200 [Trp 988; Gos 1803] and per FU year approx. EUR 3000. In the Trp cohort, total costs (index quarter + 3 years) were more than EUR 1000 below the average costs of EUR 9476 [Trp 8116; Leu 9779; n.s.].
This comparative retrospective analysis provides real-world information on initial GnRHa treatment for advanced prostate cancer, revealing differences in treatment patterns, hospitalisation rates and hospital costs in Germany.
雄激素剥夺疗法（ADT）在晚期或转移性前列腺癌（PCa）的治疗中起着关键作用。这项卫生服务研究的目的是比较不同促性腺激素释放激素激动剂和拮抗剂（GnRHa）初始使用的真实世界数据，包括处方模式、住院率和成本。
分析了2010年至2015年间来自70多家德国健康保险基金的匿名理赔数据（n = 4205227）（1年观察前期、1个初始GnRHa处方索引季度、≥2年随访（FU））。
研究人群包括2382例PCa患者（平均年龄75岁）。亮丙瑞林（Leu）的处方最为频繁（56.6%）。在初始GnRHa给药时，70%的患者既无淋巴结转移也无远处转移。在所有患者中，约11.2%在首次处方后停止GnRHa治疗，17.6%在平均457天（中位数：399天）后将初始治疗换为另一种药物；在混合（hyb）组中平均比激动剂组早100天（p = 0.016）。最常见合并症的患病率排名随时间保持一致：高血压、高脂血症、心血管疾病（CVD）和糖尿病。与拮抗剂组（6.9%，p = 0.022）和hyb组（11.6%，p = 0.006）相比，激动剂组高血压患病率显著增加（16.4%）。关于CVD，3种联合治疗类别之间的相对增长率无显著差异。在3年随访期内，所有患者中有23.9%死亡。曲普瑞林（Trp）的死亡率最低（22.1%），戈舍瑞林（Gos）的死亡率最高（29.4%，无统计学意义）。在索引季度，26.4%的患者至少有1次住院治疗[最小值 - 最大值：Trp 22.4%；Gos 30.3%]，每位患者的平均住院天数为3天[Trp 2.4；Gos 4.5]。年度住院率在36.2%至40.7%之间，整个随访期内的平均住院天数在17.6天（Trp）至20.8天（hyb）之间。索引季度的平均住院费用约为1200欧元[Trp 988；Gos 1803]，每年随访期的费用约为3000欧元。在Trp队列中，总费用（索引季度 + 3年）比平均费用9476欧元低1000多欧元[Trp 8116；Leu 9779；无统计学意义]。
这项比较性回顾分析提供了晚期前列腺癌初始GnRHa治疗的真实世界信息，揭示了德国在治疗模式、住院率和住院费用方面的差异。
