(384) Economic burden among patients with high-risk and low-to-intermediate-risk localized prostate cancer receiving radical prostatectomy in the United States

Background: : Radical prostatectomy (RP) is a potentially curative treatment option for patients with localized prostate cancer (LPC). Although prognosis for patients receiving RP is favorable, patients presenting with high-risk (HR) features (e.g., T4 staging, Gleason score ≥8, and prostate-specific antigen [PSA] level ≥20 ng/mL) may experience recurrence and greater risk of progression to metastasis. To date, there is limited information on economic burden of patients with HR-LPC treated with RP in the United States (US).

Objective: : To describe healthcare costs for patients with LPC treated with RP stratified by HR and low-to-intermediate-risk (L/IR) status.

Methods: : Clinical data from private, community-based urology practices (PPS Analytics) were linked with insurance claims data (Komodo Research Database) between 1/1/2016 and 8/31/2024. The date of the first claim for an RP procedure was defined as the index date. HR and L/IR status was based on NCCN guidelines incorporating pre-index tumor staging, Gleason score, and PSA levels. Patients with metastasis, castration resistance, or advanced treatment prior to the index date, or < 12 months of continuous pre-index insurance eligibility were excluded. Baseline (i.e., 12-month pre-index) and follow-up total healthcare costs (i.e., medical and pharmacy) per-patient-per-month (PPPM; 2024 USD) were described from the payer’s perspective.

Results: : In total, 1,488 patients with HR-LPC (mean age 63 years, 52% White, 14% Black, 60% commercially-insured, median time between diagnosis and RP 2.7 months, mean Quan-CCI 2.8) and 2,572 patients with L/IR LPC (mean age 61 years, 50% White, 15% Black, 69% commercially-insured, median time between diagnosis and RP 2.9 months, mean Quan-CCI 2.6) who received an RP were identified. Mean total baseline costs were $912 PPPM for HR patients and $789 PPPM for L/IR patients. Mean total index date (RP) costs were $21,409 (HR) and $20,930 (L/IR). During a mean overall follow-up of 29.7 months (HR) and 33.2 months (L/IR), mean total follow-up costs were numerically higher among HR patients ($3,716 PPPM) than L/IR patients ($2,749 PPPM). Outpatient costs accounted for 86% of the observed cost difference. LPC-period specific costs prior to recurrence or progression were also numerically higher among HR patients ($4,831 PPPM) than L/IR patients ($3,480 PPPM).

Conclusions: : Although patients with HR and L/IR LPC had similar baseline costs, costs increased for HR patients following RP, overall and prior to recurrence or progression, suggesting an unmet need of effective treatment options for this patient population.

Sponsorship:: Johnson & Johnson