Characterizing the real-world economic burden of metastatic castration-sensitive prostate cancer in the United States

To describe healthcare resource utilization (HRU) and costs of patients with metastatic castration-sensitive prostate cancer (mCSPC). Linked data from Flatiron Metastatic PC Core Registry and Komodo’s Healthcare Map were evaluated (01/2016-12/2021). Patients with chart-confirmed diagnoses for metastatic PC without confirmed castration resistance in Flatiron who initiated androgen deprivation therapy (ADT) monotherapy or advanced therapy for mCSPC in 2017 or later (index date) with a corresponding pharmacy or medical claim in Komodo Health were included. Advanced therapies considered were androgen-receptor signaling inhibitors, chemotherapies, estrogens, immunotherapies, poly ADP-ribose polymerase inhibitors, and radiopharmaceuticals. Patients with Of 871 patients included (mean age: 70.6 years), 52% initiated ADT monotherapy as their index treatment without documented advanced therapy use. During baseline, 31% of patients had a PC-related inpatient admission and 94% had a PC-related outpatient visit; mean all-cause costs were $2551 PPPM and PC-related costs were$839 PPPM with $787 PPPM attributable to medical costs. Patients had a mean follow-up of 15 months, during which 38$5950 PPPM with PC-related total costs of $4363 PPPM, including medical costs of$2012 PPPM. All analyses were descriptive; statistical testing was not performed. Treatment effectiveness and clinical outcomes were not assessed. This real-world study demonstrated a significant economic burden in mCSPC patients, and a propensity to use ADT monotherapy in clinical practice despite the availability and guideline recommendations of advanced life-prolonging therapies. Prostate cancer is one of the most common causes of male cancer death. Almost 1/10 men who are diagnosed early develop advanced disease. Androgen deprivation therapy (ADT), which reduces male hormone levels to slow prostate cancer growth, is part of the standard care for early-stage and advanced/metastatic hormone-sensitive prostate cancer. This form of cancer still responds to hormonal treatment. Recently, new advanced therapies targeting cancer in different ways than ADT and offering benefits in survival and disease progression have become available and are associated with improved survival compared to treatment with only ADT. However, the usage and costs of these therapies in men with advanced hormone-sensitive prostate cancer are not well-understood. Our study utilized clinical information and health insurance data to examine the treatments and healthcare costs for 871 men with advanced hormone-sensitive prostate cancer who received drug treatment between 2017–2021 in the United States. After diagnosis of advanced hormone-sensitive prostate cancer, over half of the men received only ADT without any advanced therapies. Before their disease advanced, patients with early-stage prostate cancer had $2,550 in monthly healthcare costs, increasing to almost$7,000 after the disease became advanced but before starting treatment for this advanced stage. After patients began treatment, costs were ∼$6,000 monthly, with three-quarters of this cost being directly related to prostate cancer. These results emphasize the significant healthcare costs associated with advanced prostate cancer. They underline the importance of considering comprehensive treatment options to enhance patient outcomes and potentially reduce the economic impact of advanced prostate cancer.</p

Real-world economic burden of metastatic castration-resistant prostate cancer before and after first-line therapy initiation

To describe healthcare costs of patients with metastatic castration-resistant prostate cancer (mCRPC) initiating first-line (1L) therapies from a US payer perspective. Patients initiating a Flatiron oncologist-defined 1L 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 1L, had 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 1L duration of 8.5 months, mean total costs were $13,746 (all-cause) and$12,061 (PC-related) PPPM. The cost increase following 1L 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 1L 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.</p

Comparison of Medicaid spending in schizoaffective patients treated with once monthly paliperidone palmitate or oral atypical antipsychotics

<p><b>Background</b> Compared to oral atypical antipsychotics (OAAs), long-acting injectable antipsychotics require less frequent administration, and thus may improve adherence and reduce risk of relapse in schizoaffective disorder (SAD) patients.</p> <p><b>Objective</b> To evaluate the impact of once monthly paliperidone palmitate (PP) versus OAAs on healthcare resource utilization, Medicaid spending, and hospital readmission among SAD patients.</p> <p><b>Methods</b> Using FL, IA, KS, MS, MO, and NJ Medicaid data (January 2009–December 2013), adults with ≥2 SAD diagnoses initiated on PP or OAA (index date) were identified. Baseline characteristics and outcomes were assessed during the 12month pre- and post-index periods, respectively. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to reduce confounding and compare the estimated treatment effect for PP versus OAA.</p> <p><b>Results</b> A total of 10,778 OAA-treated patients and 876 PP-treated patients were selected. Compared to OAAs, PP was associated with significantly lower medical costs (PSM: mean monthly cost difference [MMCD] = -$383, <i>p</i> < 0.001; IPTW: MMCD = -$403, <i>p</i> = 0.016), which offset the higher pharmacy costs associated with PP (PSM: MMCD = $270, <i>p</i> < 0.001; IPTW: MMCD =$350, <i>p</i> < 0.001) and resulted in similar total healthcare cost (PSM: MMCD = -$113, <i>p</i> = 0.414; IPTW: MMCD = -$53, <i>p</i> = 0.697) for PP versus OAA. Reduced risk of hospitalization (PSM: incidence rate ratio [IRR] = 0.85, <i>p</i> = 0.128; IPTW: IRR = 0.96, <i>p</i> = 0.004) and fewer hospitalization days (PSM: IRR = 0.74, <i>p</i> = 0.008; IPTW: IRR = 0.85, <i>p</i> < 0.001) were observed in PP versus OAA patients. Among hospitalized patients, PP was associated with a lower risk of 30 day hospital readmission compared to OAA (IPTW: odds ratio = 0.89, <i>p</i> = 0.041).</p> <p><b>Limitations</b> The Medicaid data may not be representative of the nation or other states, and includes pre-rebate pharmacy costs (potentially over-estimated). Also changes in treatment over time were possible.</p> <p><b>Conclusions</b> Total healthcare costs associated with the use of once monthly PP versus OAAs appeared comparable; higher pharmacy costs for PP users were offset by lower medical costs related to fewer and shorter inpatients visits.</p