Health Care Costs for Prostate Cancer Patients Receiving Androgen Deprivation Therapy: Treatment and Adverse Events

Abstract

Background: Serious adverse events have been associated with androgen deprivation therapy (ADT) for prostate cancer (PCa), but few studies address the costs of those events. Methods: All PCa patients (ICD-9-CM 185) in Ontario who started 90 days or more of ADT or had orchiectomy at the age of 66 or older during 1995–2005 (n = 26,809) were identified using the Ontario Cancer Registry and drug and hospital data. Diagnosis dates of adverse events—myocardial infarction, acute coronary syndrome, congestive heart failure, stroke, deep vein thrombosis or pulmonary embolism, any diabetes, and fracture or osteoporosis—before and after ADT initiation were determined from administrative data. We excluded patients with the same diagnosis before and after ADT, and we allocated each patient’s time from ADT initiation to death or December 31, 2007, into health states: ADT (no adverse event), ADT-AE (specified single adverse event), Multiple (>1 event), and Final (≤180 days before death). We used methods for Canadian health administrative data to estimate annual total health care costs during each state, and we examined monthly trends. Results: Approximately 50% of 21,811 patients with no preADT adverse event developed 1 or more events after ADT. The costliest adverse event state was stroke ($26,432/year). Multiple was the most frequent (n = 2,336) and the second most costly health state ($24,374/year). Costs were highest in the first month after diagnosis (from $1,714 for diabetes to $14,068 for myocardial infarction). Costs declined within 18 months, ranging from $784 per 30 days (diabetes) to $1,852 per 30 days (stroke). Adverse events increased the costs of ADT by 100% to 265%. Conclusions: The economic burden of adverse events is relevant to programs and policies from clinic to government, and that burden merits consideration in the risks and benefits of ADT.

Prostate Cancer Registries: Current Status and Future Directions

“…Although PCa-related costs vary widely across different health care systems, large administrative databases can in many cases provide an accurate estimate of the economic burden of PCa, including the cost implications of screening programs and the introduction of novel technologies [102][103][104][105][106]. Finally, data from registries can be used as the foundation for quality improvement activities in the management of PCa patients [107].…”

High PSA anxiety and low health literacy skills: drivers of early use of salvage ADT among men with biochemically recurrent prostate cancer after radiotherapy?

“…Although androgen deprivation therapy (ADT) is part of the standard initial management approach to men with metastatic prostate cancer, no survival benefit has been reported among men with PSA-only recurrence after radiotherapy (who may not develop overtly metastatic disease for years) who receive early salvage ADT, and ADT is costly and is associated with several known clinical side-effects [6][7][8]. Furthermore, the estimated direct annual cost from unproven ADT use is $42 000 and adverse events increase the costs of ADT by 100%-265% [9,10].…”

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 ) …”

“…21 Treatment distributions, health state transition probabilities, and the adverse effects of management options were derived from the literature (Tables 1 and 2). [14][15][16][21][22][23][24][25][26][27][28][29][30][31][32][33] Tracker variables counted clinical outcomes and treatment options encountered as well as direct costs and QALYs accrued by each patient over the simulated time periods. Tracker variables enabled the Curved arrows indicate cases that remained in that health state over successive cycles.…”