Kreis Kristine, Horenkamp-Sonntag Dirk, Schneider Udo, Zeidler Jan, Glaeske Gerd, Weissbach Lothar
Center for Health Economics Research Hannover (CHERH), Gottfried Wilhelm Leibniz Universität Hannover, Otto-Brenner-Straße 7, 30159, Hannover, Germany.
Versorgungsmanagement, Techniker Krankenkasse, Bramfelder Straße 140, 22305, Hamburg, Germany.
Pharmacoecon Open. 2021 Jun;5(2):299-310. doi: 10.1007/s41669-020-00219-6.
Treatments for patients with metastatic castration-resistant prostate cancer (mCRPC) have expanded rapidly. They include the chemotherapies docetaxel and cabazitaxel, hormonal drugs abiraterone and enzalutamide, and best supportive care (BSC). Cabazitaxel has proven to be the last life-prolonging option, associated with a significant risk of serious adverse events. Given the lack of real-world evidence, we aimed to compare healthcare resource utilization (HRU) and costs in patients with mCRPC treated with cabazitaxel, docetaxel, abiraterone, enzalutamide, and BSC.
We used 2014-2017 claims data from a large German statutory health insurance fund, the Techniker Krankenkasse, to identify patients with mCRPC. Patient allocation to individual therapy regimens was based on clinical knowledge and included therapy cycles, duration of therapy, and continuous treatment. The study period lasted from the first claim until death, the end of data availability, a drug switch, or discontinuation of therapy, whichever came first. Multivariate regression models were used to compare monthly all-cause and mCRPC-related HRU and costs across cohorts by adjusting for baseline covariates (including age and comorbidities).
The 3944 identified patients with mCRPC initiated treatment with cabazitaxel (n = 240), docetaxel (n = 539), abiraterone (n = 486), enzalutamide (n = 351), or BSC (n = 2328). In most domains, HRU was highest in the cabazitaxel cohort and lowest in the BSC group. Accordingly, the highest all-cause and mCRPC-related costs per month, respectively, were observed in patients receiving cabazitaxel (€7631/€6343), followed by abiraterone (€5226/€4579), enzalutamide (€5079/€4416), docetaxel (€2392/€1580), and BSC (€959/€438). Cost variations were mostly attributable to drugs, inpatient treatment, and sick leave payments.
mCRPC treatment imposes a high economic burden on statutory health insurance. Cabazitaxel is associated with substantially higher expenses, resulting from higher drug costs and a greater need for inpatient treatment. As mCRPC continues to be incurable, decision makers and clinician leaders should carefully evaluate public access to innovative agents and optimal treatment strategies.
转移性去势抵抗性前列腺癌（mCRPC）患者的治疗方法迅速增加。这些治疗方法包括化疗药物多西他赛和卡巴他赛、激素药物阿比特龙和恩杂鲁胺，以及最佳支持治疗（BSC）。卡巴他赛已被证明是最后的延长生命的选择，但伴有严重不良事件的重大风险。鉴于缺乏真实世界的证据，我们旨在比较接受卡巴他赛、多西他赛、阿比特龙、恩杂鲁胺和最佳支持治疗的mCRPC患者的医疗资源利用（HRU）和成本。
我们使用了来自德国大型法定健康保险基金Techniker Krankenkasse的2014 - 2017年理赔数据来识别mCRPC患者。根据临床知识将患者分配到各个治疗方案，包括治疗周期、治疗持续时间和持续治疗情况。研究期从首次理赔开始，直至死亡、数据可用期结束、药物更换或治疗中断，以先发生者为准。使用多变量回归模型，通过调整基线协变量（包括年龄和合并症）来比较各队列每月的全因和mCRPC相关的HRU及成本。
3944例确诊的mCRPC患者开始接受卡巴他赛（n = 240）、多西他赛（n = 539）、阿比特龙（n = 486）、恩杂鲁胺（n = 351）或最佳支持治疗（n = 2328）。在大多数领域，HRU在卡巴他赛队列中最高，在最佳支持治疗组中最低。相应地，每月全因和mCRPC相关成本最高的分别是接受卡巴他赛的患者（7631欧元/6343欧元），其次是阿比特龙（5226欧元/4579欧元）、恩杂鲁胺（5079欧元/4416欧元）、多西他赛（2392欧元/1580欧元）和最佳支持治疗（959欧元/438欧元）。成本差异主要归因于药物、住院治疗和病假支付。
mCRPC治疗给法定健康保险带来了沉重的经济负担。卡巴他赛的费用显著更高，这是由于药物成本更高以及对住院治疗的需求更大。由于mCRPC仍然无法治愈，决策者和临床领导者应仔细评估公众获得创新药物和最佳治疗策略的情况。
