Treatment-Related Healthcare Costs of Metastatic Castration-Resistant Prostate Cancer in Germany: A Claims Data Study

Abstract

Purpose Treatments for patients with metastatic castration-resistant prostate cancer (mCRPC) have expanded rapidly. They include the chemotherapies docetaxel and cabazitaxel, hormonal drugs abiraterone and enzalutamide, and best supportive care (BSC). Cabazitaxel has proven to be the last life-prolonging option, associated with a significant risk of serious adverse events. Given the lack of real-world evidence, we aimed to compare healthcare resource utilization (HRU) and costs in patients with mCRPC treated with cabazitaxel, docetaxel, abiraterone, enzalutamide, and BSC. Methods We used 2014-2017 claims data from a large German statutory health insurance fund, the Techniker Krankenkasse, to identify patients with mCRPC. Patient allocation to individual therapy regimens was based on clinical knowledge and included therapy cycles, duration of therapy, and continuous treatment. The study period lasted from the first claim until death, the end of data availability, a drug switch, or discontinuation of therapy, whichever came first. Multivariate regression models were used to compare monthly all-cause and mCRPC-related HRU and costs across cohorts by adjusting for baseline covariates (including age and comorbidities). Results The 3944 identified patients with mCRPC initiated treatment with cabazitaxel (n = 240), docetaxel (n = 539), abiraterone (n = 486), enzalutamide (n = 351), or BSC (n = 2328). In most domains, HRU was highest in the cabazitaxel cohort and lowest in the BSC group. Accordingly, the highest all-cause and mCRPC-related costs per month, respectively, were observed in patients receiving cabazitaxel (€7631/€6343), followed by abiraterone (€5226/€4579), enzalutamide (€5079/€4416), docetaxel (€2392/€1580), and BSC (€959/€438). Cost variations were mostly attributable to drugs, inpatient treatment, and sick leave payments. Conclusion mCRPC treatment imposes a high economic burden on statutory health insurance. Cabazitaxel is associated with substantially higher expenses, resulting from higher drug costs and a greater need for inpatient treatment. As mCRPC continues to be incurable, decision makers and clinician leaders should carefully evaluate public access to innovative agents and optimal treatment strategies.

Healthcare Costs for Metastatic Castration-Resistant Prostate Cancer Patients Treated with Abiraterone or Enzalutamide

“…There were a handful of studies based on real-world data with which we could compare our results. The treatment stratification in these studies differed: one focused only on abiraterone patients [9], none focused on enzalutamide patients exclusively, and four focused on both treatments [8,[10][11][12]. The studies also varied in their focus of settings: three included only pre-chemotherapy setting [10][11][12] and two included both pre-and post-chemotherapy settings [8,9].…”

“…The treatment stratification in these studies differed: one focused only on abiraterone patients [9], none focused on enzalutamide patients exclusively, and four focused on both treatments [8,[10][11][12]. The studies also varied in their focus of settings: three included only pre-chemotherapy setting [10][11][12] and two included both pre-and post-chemotherapy settings [8,9]. In most studies including both treatments, patients were frequently prescribed abiraterone [8,[10][11][12].…”

“…The studies also varied in their focus of settings: three included only pre-chemotherapy setting [ 10 – 12 ] and two included both pre- and post-chemotherapy settings [ 8 , 9 ]. In most studies including both treatments, patients were frequently prescribed abiraterone [ 8 , 10 – 12 ]. This pattern was observed in our study as well.…”

“…This pattern was observed in our study as well. The majority of studies conclude that the total healthcare costs of abiraterone and enzalutamide patients did not differ much [ 8 , 10 , 12 ]. One claims that total cost was lower for enzalutamide-treated patients than for abiraterone-treated patients [ 11 ].…”

“…A recent systematic review [7] on cost-effectiveness analyses and cost analyses of mCRPC treatments confirms these uncertainties, including those attributed to misleading or missing cost information, and insufficient details provided by analyses in its consideration. Moreover, few costing studies [8][9][10][11][12] have to date utilised real-world data despite the expansion in prescription of abiraterone and enzalutamide to patients in the last decade. These studies utilised data obtained from claims and research databases such as the IBM MarketScan ® from the providers' perspectives.…”