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P213: Real-World Outpatient Cost of Care among Patients with Metastatic, Castrate-resistant Prostate Cancer (mCRPC)

Poster Presenter

Zhaohui Su

Vice President, Biostatistics
McKesson
United States

Objectives

To describe real-world patient characteristics and outpatient cost of care, including changes in cost over time, among patients with metastatic, castrate-resistant prostate cancer (mCRPC) treated in The US Oncology Network.

Method

This was a retrospective observational analysis of adult men with mCRPC treated between 01/2015-12/2022. Electronic health records linked to claims data were used to describe costs (paid amount) within 12 months of initiation of chemotherapy (standardized to 2022 US dollars).

Results

The study included an eligible subset of 1,845 patients. The median (Q1, Q3) age at diagnosis was 69 (63, 74) years. Of the 1,553 (84%) patients with race information, the majority were White (79%), followed by Black (16%), and other races (5%). Practices where patients received care were geographically dispersed across the West (45%), South (35%), Midwest (17%) and Northeast (3%), with about 3% of patients being treated in rural areas. The payer type distribution was Medicare/Medicaid (52%), Commercial (47%) and other insurance (1%). The median (Q1, Q3; same below) total outpatient medical care cost measured as per patient per month (PPPM) linearly increased from $3,123 ($1,374, $8,040) in 2015 to $5,779 ($2,508, $11,202) in 2019 (p=0.01), and slightly decreased to $4,930 ($1,823, $9,242) in 2021. Descriptive analyses showed that the costs were higher for patients <65 years ($4,804 [$2,179, $9,776]) and =85 years ($5,898 [$1,823, 10,636]) compared to other age groups. Consistently across all years, the largest proportions of the medical cost were due to chemotherapy (mean [standard deviation]; the same below): 40% (30%), and other medications: 30% (30%). The cost of chemotherapies as a proportion of total medical cost continued to grow in the past 5 years, from 36% (31%) in 2017 to 47% (30%) in 2021. The 2022 data supported this trend but had incomplete claims data in recent months. The proportion of chemotherapy cost was the highest among Asian patients, compared with those for Black patients and White patients (45% [32%], 39% [28%] and 40% [30%], respectively).

Conclusion

This retrospective real-world analysis of men with mCRPC assessed the cost of care in community oncology settings in the US. These findings demonstrated increased costs associated with treatment of this type of cancer since 2015, particularly for chemotherapies that accounted for about 40% of the overall outpatient costs. Results from this study may provide oncology stakeholders with insights into how advancements in prostate cancer care have influenced rising costs. Additionally, descriptive analyses showed differences in costs among age and race categories and future research should explore clinical and social determinants of health that may be influencing these trends.