Bilen Mehmet A, Lowentritt Benjamin, Burbage Sabree, Kinkead Frederic, Khilfeh Ibrahim, Rossi Carmine, Du Shawn, Wong Gordon, Pilon Dominic, Joshi Kruti, Shore Neal D
Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Chesapeake Urology, Towson, Maryland, USA.
J Med Econ. 2025 Dec;28(1):1096-1109. doi: 10.1080/13696998.2025.2530865. Epub 2025 Jul 16.
This retrospective longitudinal cohort study compared healthcare resource utilization (HRU) and costs among patients with metastatic castration (hormone)-sensitive prostate cancer who initiated apalutamide or enzalutamide, two androgen receptor pathway inhibitors (ARPIs) that have demonstrated efficacy in the treatment of advanced prostate cancer in phase 3 clinical trials.
Linked patient-level data from a practice-related clinical urology database and an administrative claims database in the United States (1 January 2016-31 December 2023) were used. Per-patient-per-month (PPPM) HRU and cost outcomes were compared between the apalutamide and enzalutamide cohorts during the observation period (i.e. from ARPI initiation until continuous insurance eligibility end) after inverse probability treatment weighting to balance differences in baseline characteristics.
Overall, 486 patients who initiated apalutamide (mean age 70.3 years, 53.5% white, 25.4% Black, 58.1% Medicare-insured) and 601 patients who initiated enzalutamide (mean age 70.5 years, 52.9% white, 25.5% Black, 58.8% Medicare-insured) were included. Duration of continuous treatment use was 9.6 months for apalutamide and 8.6 months for enzalutamide. Despite longer continuous ARPI use among patients treated with apalutamide relative to enzalutamide, the number of inpatient admissions (rate ratio [RR] = 0.58; 95% confidence interval [CI] = 0.37, 0.86; = 0.012), number of admission days (RR = 0.58; 95% CI = 0.19, 0.70; = 0.004), as well as all-cause medical costs (mean monthly cost difference = -$1,845; 95% CI = -$52, -$4,908; = 0.044) were significantly lower in the apalutamide cohort than the enzalutamide cohort during the observation period. Mean monthly all-cause pharmacy costs between the cohorts was not significantly different ($2,121; 95% CI = -2,389, 5,703; = 0.320).
This study relied on administrative claims and clinical data, which may contain coding inaccuracies or omissions. While linkages between the data sources are comprehensive, any mislinkages may have led to misclassification and information bias.
The findings of this study suggest that apalutamide may result in better economic outcomes relative to enzalutamide.
本回顾性纵向队列研究比较了开始使用阿帕他胺或恩杂鲁胺的转移性去势（激素）敏感性前列腺癌患者的医疗资源利用（HRU）和成本。阿帕他胺和恩杂鲁胺是两种雄激素受体通路抑制剂（ARPI），在3期临床试验中已证明对晚期前列腺癌有效。
使用了来自美国一个与实践相关的临床泌尿外科数据库和一个行政索赔数据库的患者层面关联数据（2016年1月1日至2023年12月31日）。在观察期内（即从开始使用ARPI到连续保险资格结束），经过逆概率治疗加权以平衡基线特征差异后，比较了阿帕他胺和恩杂鲁胺队列之间的每月每患者（PPPM）HRU和成本结果。
总体而言，纳入了486例开始使用阿帕他胺的患者（平均年龄70.3岁，53.5%为白人，25.4%为黑人，58.1%有医疗保险）和601例开始使用恩杂鲁胺的患者（平均年龄70.5岁，52.9%为白人，25.5%为黑人，58.8%有医疗保险）。阿帕他胺的连续治疗使用时间为9.6个月，恩杂鲁胺为8.6个月。尽管接受阿帕他胺治疗的患者相对于恩杂鲁胺治疗的患者连续使用ARPI的时间更长，但在观察期内阿帕他胺队列的住院入院次数（率比[RR]=0.58；95%置信区间[CI]=0.37，0.86；P=0.012）、入院天数（RR=0.58；95%CI=0.19，0.70；P=
