Burden of illness of bone metastases in prostate cancer patients in Québec, Canada: A population-based analysis

Abstract

Introduction: Metastasis of prostate cancer (PC) to bone (metastatic bone disease, MBD) increases morbidity, but Canadian data are lacking on the associated healthcare resource utilization (HCRU) and costs. We quantified MBD-related HCRU and associated costs in this population, and assessed skeletal-related events (SREs), such as pathologic fracture, spinal cord compression, bone radiotherapy, and bone surgery. Methods: We conducted a retrospective, population-based cohort study using the Québec health insurance agency database. Prescription drug and medical services data were retrieved for patients with ≥1 healthcare claim in 2001 with a PC diagnosis (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] code of 185.xx). Patients with ≥2 MBDrelated claims or an SRE were compared with a matched-control group of PC patients without MBD. Patients were followed until death, loss to follow-up, or the end of available data (August 31, 2010). Costs (in 2012 Canadian dollars) were adjusted for age, year of MBD diagnosis, general health status, and baseline resource utilization. Results: Compared with controls (n = 1671), MBD patients (n = 626) had significantly higher HCRU. Adjusted mean (95% confidence interval) all-cause healthcare costs were $11 820 (7248-16 058) higher, and MBD-related costs were $3 091 (1267-4861) higher in MBD patients than in controls. Nearly 50% of MBD patients received radiotherapy within 2.5 years of their MBD diagnosis, but most exited the study without experiencing other SREs. Conclusion: MBD imposes a heavy HCRU and cost burden among patients with PC in Canada. Effective therapy is needed to reduce the clinical and economic impact of MBD in this population.

Management of localized and advanced prostate cancer in Canada: A lifetime cost and quality‐adjusted life‐year analysis

“…Costs were apportioned to represent resources used to treat patients with PCa in routine clinical practice for initial care, delayed treatments (for patients who came off AS), subsequent care, follow‐up care, mCRPC care, and end‐of‐life care. All costs were adjusted to 2014 Canadian dollars using the Canadian Consumer Price Index (Table ) …”

“…All costs were adjusted to 2014 Canadian dollars using the Canadian Consumer Price Index (Table 3). 12,13,16,27,[35][36][37][38][39][40][41]…”

State-of-the-art imaging for diagnosis of metastatic bone disease

“…An up to tenfold surge in the risk of death depending on the histology of the primary malignancy [2] has been reported, with a documented negative impact on progression-free survival [3]. Studies stipulate that the presence of MBD increases the cost of patient care by 62-300%, with an average of $ 11,820 higher annual health-care costs than for controls [4][5][6][7]. The estimated lifetime cost of a skeletal-related event (SRE) was reported to be up to 12,000 $ per patient with lung cancer in 2004.…”

Oncolytic adenovirus-mediated therapy for prostate cancer

“…Aggressive disease is characterized by invasion through the prostate capsule and spread to surrounding lymph nodes and distal organs, including bone, liver, and lung 17. Although many elderly men may die from other causes associated with advanced age, the metastases in vertebrae and pelvic bones cause severe morbidity, including pain and decreased quality of life 18,19. Treatment of late-stage metastatic disease includes chemotherapy and radiation therapy but have mostly palliative effects, and no curative therapies are currently available.…”