Joyce Daniel D, Sharma Vidit, Jiang David H, Van Houten Holly K, Sangaralingham Lindsey R, Borah Bijan J, Kwon Eugene D, Penson David F, Dusetzina Stacie B, Tilburt Jon C, Boorjian Stephen A
Department of Urology, Mayo Clinic, Rochester, Minnesota.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.
J Urol. 2022 Nov;208(5):987-996. doi: 10.1097/JU.0000000000002856. Epub 2022 Sep 12.
Out-of-pocket costs represent an important component of financial toxicity and may impact patients' receipt of care. Herein, we evaluated patient-level factors associated with out-of-pocket costs for contemporary advanced prostate cancer treatment options.
We identified all commercially insured men receiving treatment for advanced prostate cancer between 2007 and 2019 within the OptumLabs Data Warehouse®. Patients were categorized into 3 treatment groups: androgen deprivation monotherapy, novel hormonal therapy, and nonandrogen systemic therapy. The primary outcome was out-of-pocket costs in the first year of treatment. The associations of treatment and patient variables with out-of-pocket costs were assessed using multivariable regression models. All costs were adjusted to reflect 2019 U.S. dollars using the Consumer Price Index.
In a cohort of 13,409 men 81% (n = 10,926) received androgen deprivation monotherapy, 6% (n = 832) novel hormonal therapy, and 12% (n = 1,651) nonandrogen systemic therapy. Mean treatment-related out-of-pocket costs in the first year were $165, $4,236, and $994 for androgen deprivation monotherapy, novel hormonal therapy, and nonandrogen systemic therapy, respectively. The adjusted difference in annual treatment-related out-of-pocket costs for novel hormonal therapy and nonandrogen systemic therapy were $2,581 (95% CI: $1,923-$3,240) and $752 (95% CI: $600-$903) higher than androgen deprivation monotherapy, respectively. Patient characteristics associated ( < .05) with higher treatment-related out-of-pocket costs included older age (65-74 years), Black race, lower comorbidity scores, and lower household income.
Patients receiving novel hormonal therapy for advanced prostate cancer had substantially higher treatment-related out-of-pocket costs. In addition to raising awareness among prescribers, these data support the inclusion of treatment associated financial toxicity in shared decision making for advanced prostate cancer and call attention to subgroups of patients particularly vulnerable to financial toxicity.
自付费用是经济毒性的一个重要组成部分，可能会影响患者获得治疗的情况。在此，我们评估了与当代晚期前列腺癌治疗方案的自付费用相关的患者层面因素。
我们在OptumLabs Data Warehouse®中确定了2007年至2019年间所有接受晚期前列腺癌治疗的商业保险男性。患者被分为3个治疗组：雄激素剥夺单一疗法、新型激素疗法和非雄激素全身疗法。主要结局是治疗第一年的自付费用。使用多变量回归模型评估治疗和患者变量与自付费用的关联。所有费用均使用消费者价格指数进行调整，以反映2019年的美元价值。
在13409名男性队列中，81%（n = 10926）接受了雄激素剥夺单一疗法，6%（n = 832）接受了新型激素疗法，12%（n = 1651）接受了非雄激素全身疗法。雄激素剥夺单一疗法、新型激素疗法和非雄激素全身疗法在治疗第一年的平均治疗相关自付费用分别为165美元、4236美元和994美元。新型激素疗法和非雄激素全身疗法每年治疗相关自付费用的调整差异分别比雄激素剥夺单一疗法高2581美元（95%CI：1923美元 - 3240美元）和752美元（95%CI：600美元 - 903美元）。与较高治疗相关自付费用相关（P <.05）的患者特征包括年龄较大（65 - 74岁）、黑人种族、较低的合并症评分和较低的家庭收入。
接受新型激素疗法治疗晚期前列腺癌的患者治疗相关自付费用显著更高。除了提高开处方者的认识外，这些数据支持在晚期前列腺癌的共同决策中纳入治疗相关的经济毒性，并呼吁关注特别容易受到经济毒性影响的患者亚组。
