Duke University Cancer Center, Durham, NC, USA.
Janssen Scientific Affairs, LLC., Horsham, PA, USA.
J Med Econ. 2024 Jan-Dec;27(1):201-214. doi: 10.1080/13696998.2024.2303890. Epub 2024 Feb 2.
To describe healthcare costs of patients with metastatic castration-resistant prostate cancer (mCRPC) initiating first-line (1 L) therapies from a US payer perspective.
Patients initiating a Flatiron oncologist-defined 1 L mCRPC therapy (index date) on or after mCRPC diagnosis were identified from linked electronic medical records/claims data from the Flatiron Metastatic Prostate Cancer (PC) Core Registry and Komodo's Healthcare Map. Patients were excluded if they initiated a clinical trial drug in 1 L, had <12 months of insurance eligibility prior to index, or no claims in Komodo's Healthcare Map for the Flatiron oncologist-defined index therapy. All-cause and PC-related total costs per-patient-per-month (PPPM), including costs for services and procedures from medical claims (i.e. medical costs) and costs from pharmacy claims (i.e. pharmacy costs), were described in the 12-month baseline period before 1 L therapy initiation (including the baseline pre- and post- mCRPC progression periods) and during 1 L therapy (follow-up).
Among 459 patients with mCRPC (mean age 70 years, 57% White, 16% Black, 45% commercially-insured, 43% Medicare Advantage-insured, and 12% Medicaid-insured), average baseline all-cause total costs (PPPM) were $4,576 ($4,166 pre-mCRPC progression, $8,278 post-mCRPC progression). Average baseline PC-related total costs were $2,935 ($2,537 pre-mCRPC progression, $6,661 post-mCRPC progression). During an average 1 L duration of 8.5 months, mean total costs were $13,746 (all-cause) and $12,061 (PC-related) PPPM. The cost increase following 1 L therapy initiation was driven by higher PC-related outpatient and pharmacy costs. PC-related medical costs PPPM increased from $1,504 during baseline to $5,585 following 1 L mCRPC therapy initiation.
All analyses were descriptive; statistical testing was not performed.
Incremental costs of progression to mCRPC are significant, with the majority of costs driven by higher PC-related costs. Using contemporary data, this study highlights the importance of utilizing effective therapies that slow progression and reduce healthcare resource demands despite the initial investment in treatment costs.
从美国支付者的角度描述转移性去势抵抗性前列腺癌（mCRPC）患者接受一线（1L）治疗的医疗保健费用。
从 Flatiron 转移性前列腺癌（PC）核心注册中心和 Komodo 的医疗保健地图的电子病历/索赔数据中，确定自 mCRPC 诊断后开始接受 Flatiron 肿瘤医生定义的 1L mCRPC 治疗（索引日期）的患者。如果患者在 1L 中接受临床试验药物、在索引前的 12 个月内没有保险资格或在 Flatiron 肿瘤医生定义的索引治疗中没有 Komodo 的医疗保健地图索赔，则将其排除在外。在开始 1L 治疗前的 12 个月基线期（包括基线前和 mCRPC 进展期）和 1L 治疗期间（随访），按每位患者每月（PPPM）描述所有原因和前列腺癌相关的总费用，包括医疗索赔（即医疗费用）和药房索赔（即药房费用）的服务和程序费用。
在 459 名 mCRPC 患者中（平均年龄 70 岁，57%为白人，16%为黑人，45%为商业保险，43%为医疗保险优势保险，12%为医疗补助保险），平均基线全因总费用（PPPM）为 4576 美元（4166 美元在 mCRPC 进展前，8278 美元在 mCRPC 进展后）。平均基线前列腺癌相关总费用为 2935 美元（2537 美元在 mCRPC 进展前，6661 美元在 mCRPC 进展后）。在平均 8.5 个月的 1L 期间，平均总费用为 13746 美元（全因）和 12061 美元（前列腺癌相关）PPPM。1L 治疗开始后总费用的增加是由前列腺癌相关的门诊和药房费用增加引起的。1L mCRPC 治疗后，前列腺癌相关的医疗费用 PPPM 从基线时的 1504 美元增加到 5585 美元。
所有分析均为描述性的；未进行统计检验。
进展为 mCRPC 的增量成本是显著的，其中大部分成本是由更高的前列腺癌相关成本驱动的。本研究使用当代数据，强调了使用能够减缓疾病进展并降低医疗资源需求的有效治疗方法的重要性，尽管初始治疗费用较高。
