Cost of Metastatic Prostate Cancer in the US

 

T. Anders Olsen

, 

Christopher P. Filson

, 

Thomas B. Richards

, 

Donatus U. Ekwueme

, and 

David H. Howard

View All Author Information

https://doi.org/10.1097/UPJ.0000000000000363

Abstract

Introduction:

We sought to estimate per patient and annual aggregate health care costs related to metastatic prostate cancer.

Methods:

Using the Surveillance, Epidemiology, and End Results-Medicare database, we identified fee-for-service Medicare beneficiaries ages 66 and older diagnosed with metastatic prostate cancer or claims with diagnosis codes for metastatic disease (indicating tumor progression following diagnosis) between 2007 and 2017. We measured annual health care costs and compared costs between cases and a sample of beneficiaries without prostate cancer.

Results:

We estimate that per-patient annual costs attributable to metastatic prostate cancer are $31,427 (95% CI: $31,219-$31,635; 2019 dollars). Annual attributable costs rose over time, from $28,311 (95% CI: $28,047-$28,575) in 2007-2013 to $37,055 (95% CI: $36,716-$37,394) in 2014-2017. In aggregate, health costs attributable to metastatic prostate cancer are $5.2 to $8.2 billion per year.

Conclusions:

The per patient annual health care costs attributable to metastatic prostate cancer are substantial and have increased over time, corresponding to the approval of new oral therapies used in treating metastatic prostate cancer.

After the wide adoption of prostate cancer screening with PSA testing, there was a marked decrease in the population-level incidence of metastatic prostate cancer in the United States.1 But in 2008, the United States Preventive Services Task Force recommended against routine PSA screening for men over 75 and in 2012 recommended against routine PSA screening for all men.2 Following these recommendations, the incidence of metastatic prostate cancer has steadily increased. From 2008 to 2014, the incidence of metastatic prostate cancer increased by 4.4 per 100,000 persons,3 possibly due to changes in screening recommendations.4-6

For men with metastatic prostate cancer, androgen deprivation therapy as monotherapy has been the standard of care for decades.7 However, men with castrate-resistant disease do not respond to androgen deprivation therapy, and before 2010 docetaxel was the only available treatment option. Since 2010, the U.S. Food and Drug Administration has approved a number of new treatments, including radium-223, sipuleucel-T, abiraterone, and enzalutamide (supplementary Table 1, https://www.urologypracticejournal.com). Though effective and likely cost-effective,8 these novel therapies are costlier.9 Many cost close to $10,000 per month.10 In light of the increasing prevalence of metastatic disease and the approval and adoption of costlier therapies for metastatic prostate cancer, we sought to characterize the association between metastatic prostate cancer and spending. Further, we examined the effect on overall health care spending, longitudinal trends in spending, and estimated the total cost of treatment for metastatic prostate cancer.

https://www.auajournals.org/doi/10.1097/UPJ.0000000000000363