Pfizer Inc., New York, NY, USA.
Pfizer Inc., San Francisco, CA, USA.
Adv Ther. 2020 May;37(5):2083-2097. doi: 10.1007/s12325-020-01260-x. Epub 2020 Feb 28.
Prostate cancer (PC) is the second leading cause of cancer death among US men and accounts for considerable healthcare expenditures. We evaluated economic outcomes in men with chemotherapy-naïve metastatic castration-resistant PC (mCRPC) treated with enzalutamide or abiraterone acetate plus prednisone (abiraterone).
We performed a retrospective analysis on 3174 men (18 years or older) utilizing the Veterans Health Administration (VHA) database from 1 April 2014 to 31 March 2018. Men with mCRPC were included if they had at least one pharmacy claim for enzalutamide or abiraterone (first claim date = index date) following surgical or medical castration, had no chemotherapy treatment within 12 months prior to the index date, and had continuous VHA enrollment for at least 12 months pre- and post-index date. Men were followed until death, disenrollment, or end of study and were 1:1 propensity score matched (PSM). All-cause and PC-related resource use and costs per patient per month (PPPM) in the 12 months post index were compared between matched cohorts.
We identified 1229 men with mCRPC prescribed enzalutamide and 1945 prescribed abiraterone with mean ages of 74 and 73 years, respectively. After PSM, each cohort had 1160 patients. The enzalutamide cohort had fewer all-cause (2.51 vs 2.86; p < 0.0001) and PC-related outpatient visits (0.86 vs 1.03; p < 0.0001), with corresponding lower all-cause ($2588 vs $3115; p < 0.0001) and PC-related ($1356 vs $1775; p < 0.0001) PPPM outpatient costs compared with the abiraterone cohort. All-cause total costs (medical and pharmacy) PPPM ($8085 vs $9092; p = 0.0002) and PC-related total costs PPPM ($6321 vs $7280; p < 0.0001) were significantly lower in the enzalutamide cohort compared with the abiraterone cohort.
Enzalutamide-treated men with chemotherapy-naïve mCRPC had significantly lower resource utilization and healthcare costs compared with abiraterone-treated men.
前列腺癌（PC）是美国男性癌症死亡的第二大主要原因，也是医疗保健支出的主要原因。我们评估了接受恩扎卢胺或阿比特龙联合泼尼松治疗的化疗初治转移性去势抵抗性前列腺癌（mCRPC）男性的经济结局。
我们利用退伍军人健康管理局（VHA）数据库进行了一项回顾性分析，共纳入了 3174 名年龄在 18 岁或以上的男性，时间范围为 2014 年 4 月 1 日至 2018 年 3 月 31 日。如果患者在接受手术或药物去势后至少有一次恩扎卢胺或阿比特龙的药房配药（首次配药日期=索引日期），且在索引日期前 12 个月内没有化疗治疗，并且在索引日期前后至少有 12 个月的连续 VHA 登记，则认为患者患有 mCRPC。患者在死亡、退出或研究结束前被随访，并且进行了 1:1 的倾向评分匹配（PSM）。在索引后 12 个月内，比较匹配队列中每位患者的全因和前列腺癌相关资源使用情况和每月每位患者的费用（PPPM）。
我们确定了 1229 名接受恩扎卢胺治疗和 1945 名接受阿比特龙治疗的 mCRPC 患者，平均年龄分别为 74 岁和 73 岁。在 PSM 后，每个队列各有 1160 名患者。恩扎卢胺组的全因（2.51 比 2.86；p<0.0001）和前列腺癌相关的门诊就诊次数（0.86 比 1.03；p<0.0001）均更少，相应的全因（2588 美元比 3115 美元；p<0.0001）和前列腺癌相关的门诊就诊（1356 美元比 1775 美元；p<0.0001）每月每位患者的费用（PPPM）也更低与阿比特龙组相比。全因（医疗和药房）每月每位患者的总费用（PPPM）（8085 美元比 9092 美元；p=0.0002）和前列腺癌相关的每月每位患者的总费用（PPPM）（6321 美元比 7280 美元；p<0.0001）在恩扎卢胺组均显著低于阿比特龙组。
与接受阿比特龙治疗的患者相比，接受恩扎卢胺治疗的化疗初治 mCRPC 男性的资源利用率和医疗保健成本显著降低。
