(327) Healthcare resource utilization (HCRU) and costs among chemotherapy-naïve patients with metastatic castration‑resistant prostate cancer (mCRPC): a real-world assessment using data from the Veterans Affairs Healthcare System (VAHCS)

Background: : Patients with mCRPC are treated with either androgen receptor pathway inhibitors (ARPI) or chemotherapy in the first-line (1L) based on patient symptoms and prior treatments received. However, mCRPC treatment can generate substantial HCRU and costs through symptom management and treatment-related adverse events (AE). To better understand the impact of the optimal treatment sequence of mCRPC, we assessed the differences in HCRU and cost between the two most common 1L mCRPC treatments and quantified differences in AE-related HCRU.

Objective: : To determine HCRU and costs among chemotherapy-naïve patients with mCRPC who received ARPI or taxane as 1L systemic treatment at the VAHCS, an equal-access healthcare system.

Methods: : This retrospective, observational study used VAHCS data from patients diagnosed with mCRPC between January 2018 and February 2024, who received 1L treatment with ARPI (abiraterone, enzalutamide, darolutamide, or apalutamide) or taxane (docetaxel or cabazitaxel). Index date was the date of 1L treatment initiation. HCRU and costs were evaluated from index date to date of most recent follow-up or death. AEs-related costs were evaluated over a 30-day period from the date of first inpatient or emergency department (ED) claim for an AE.

Results: : We included 2,982 patients (ARPI: 2,828 [95%]; taxane: 154 [5%]) who initiated 1L therapy for mCRPC during the study period. Overall, 24% of patients had at least 1 inpatient hospitalization during the first year of follow-up (ARPI: 23%; taxane: 40%), with a mean length of stay of 5 days and a mean admission cost of $22,356 (ARPI: $22,000; taxane: $28,881) per patient per year (PPPY). Furthermore, 37% of patients had at least 1 ED visit (ARPI: 36%; taxane: 59%) with a mean cost of $1,097 (ARPI: $1,584; taxane: $1,071) PPPY. In total, 35% of patients had 3 or more documented AEs (ARPI: 34%; taxane: 61%), with 4% requiring at least 1 inpatient hospitalization due to an AE (ARPI: 4%; taxane: 13%), and 13% requiring at least 1 ED visit due to AEs (ARPI: 13%; taxane: 22%). In comparison, a mean of 42 outpatient visits PPPY was observed in total between the two cohorts with a mean cost of $38,194 (ARPI: $37,970; taxane: $42,313) PPPY.

Conclusions: : HCRU and costs among patients with mCRPC were substantial regardless of whether they received 1L ARPI or taxane chemotherapy, leading to a significant burden on the healthcare system. Attempts to delay castration-resistance in prostate cancer and further research into treatment sequencing are needed to optimize care.

Sponsorship:: Novartis Pharmaceuticals Corporation