Abstract and Introduction
Abstract
Aim To describe treatments and cost of care for prostate cancer (PCa) in hospital-based outpatient and inpatient settings.
Methods Hospital encounters associated with PCa (ICD-9 codes 185, 233.4) and PCa-related treatment in a hospital claims database were included.
Results There were 211,440 encounters for PCa between January 2006 and December 2010 (88,151 inpatient and 123,289 outpatient). Average cost per inpatient stay was US$12,286 versus US$4364 per outpatient visit. Most common treatment during an inpatient stay and outpatient visit was surgery (57%) and radiation (76%), respectively. A total of 80% of outpatient visits and 69.9% inpatient stays were associated with a single treatment; remaining encounters were associated with ≥2 treatments.
Conclusion Costs are consistent with previous estimates; however, multimodal therapy is an emerging trend that may be related to greater costs in the future which may also be a challenge for hospital decision makers.
Introduction
Prostate cancer (PCa) is the most common malignancy in men in the USA. More than 241,700 new cases of PCa were diagnosed in 2012, representing 29% of all cancer diagnoses, and 28,170 men died from this cancer, encompassing 9% of all cancer deaths. The lifetime risk of developing PCa for men in the USA is 16%, meaning that one in six men have a chance to be eventually diagnosed with this cancer.
The vast majority (93%) of patients present with localized or regional PCa have a 5-year survival rate of 100%. In contrast, 4% of patients have metastatic prostate cancer (MPC) at diagnosis and have an unfavorable 5-year survival rate of 29%. In addition, about a third of men are at risk of developing progressive PCa to distant sites (lymph nodes and bones, among others), despite initial diagnosis of early stage disease.
The treatment for early PCa is curative and comprises an individualized approach (radical prostatectomy, radiation or watchful waiting) based on life expectancy, comorbidities and toxicities of treatment. The treatment of advanced PCa is palliative, with androgen deprivation therapy with medical or surgical castration being the preferred first-line treatment option. At subsequent progressions, options such as abiraterone acetate, cabazitaxel, secondary androgen deprivation therapy and enrollment in a clinical trial can be considered, but there is no therapeutic consensus regarding the best agent to be used. In addition, novel agents such as radium-223 and enzalutamide have recently shown overall survival (OS) benefit and delayed the time to first on-study skeletal-related event in this patient population.
Overall, PCa is associated with a high economic burden in the USA; the total cost of care was estimated at about US$12 billion in 2010 (up from US$10 billion in 2006), ranking PCa as the fifth highest cancer in terms of national expenditures. It is important to point out that this estimate did not include any of the recent therapeutic advances in the management of MPC that will likely impact patterns of care and healthcare spending. Furthermore, 2020 projections based on increasing prevalence of PCa are indicating that the cost for PCa will rise to US$16 billion. The high economic burden of PCa was also predicted from a model analysis of the Surveillance Epidemiology and End Results (SEER) database that estimated a lifetime cost of US$110,520 (95% CI: US$110,324–110,739) per patient.
Keeping in mind the overall healthcare spending for PCa, it has been well documented that the majority of care occurs in an outpatient setting. However, Milenkovic et al. found, using data from the Healthcare Cost and Utilization Project (HCUP), that nearly half a million hospitalizations in 2004 (81,300 as primary diagnosis; 416,700 as secondary diagnosis) in the USA involved PCa, highlighting that a substantial proportion of the cost was associated with PCa care completed in the inpatient hospital setting. A considerable amount of inpatient care was also documented in retrospective analyses from the PharMetrics database (2000–2005) and the SEER-Medicare database (2000). However, no studies to date have documented specific treatment patterns of care within both the hospital-based outpatient and inpatient setting, which is crucial for hospital-based decision makers given the changing landscape of prostate cancer treatment. As such, this study sought to describe treatments used and the associated cost of care for PCa patients who have received PCa-related treatment in an inpatient or hospital-based outpatient setting at some point during their care.