Time burden and healthcare costs associated with docetaxel in patients with metastatic castration-sensitive prostate cancer (mCSPC) initiating an androgen receptor pathway inhibitor (ARPI) –based regimen.

Abstract

58 Background: Prior to ARPIs, chemotherapy was used to treat mCSPC. Recently, intensifying mCSPC treatment with a triplet combination of chemotherapy, ARPI and androgen deprivation therapy (ADT) has been a recommended approach. Few recent studies explore time burden and costs associated with chemotherapy-containing regimens (CCR) relative to non-chemotherapy containing regimens (NCR). This study compared the additive burden of docetaxel to ADT and ARPI combination by assessing the number of days needed to manage prostate cancer (PC) care and healthcare costs among patients with mCSPC receiving CCR or NCR in the US. Methods: Clinical data from community urology practices (PPS Analytics) linked with the Komodo Research Database (1/1/2016-12/31/2023) were used to identify patients initiating a CCR or NCR. The index date was earliest of ARPI or docetaxel initiation. Patients were followed from index until earliest of 12 months, ARPI discontinuation, start of new ARPI, chemotherapy initiation (NCR cohort only), or end of insurance/data availability. Outcomes reported per-patient-per-month (PPPM) included time spent managing mCSPC (total days with PC-related resource utilization [inpatient admissions, outpatient, emergency room, and other PC-related visits]) or PC management care (imaging, biopsy, chemotherapy management [iron/blood transfusions, erythropoiesis-stimulating agents, granulocyte colony-stimulating factor], testing), and all-cause and PC-related healthcare costs ($2023 US dollars). Cohorts were balanced on baseline covariates using overlap weighting. Outcomes were compared using weighted multivariable Poisson and linear regression models. Results: A total of 126 CCR and 837 NCR patients were identified (mean age 64.7 years, 52.6% White, 14.4% Black, and 33.7% had visceral metastasis in both cohorts). Patients were followed for a mean of 6.3 (CCR) and 6.8 (NCR) months. For the CCR cohort, a mean of 4.0 docetaxel infusions were observed per patient (mean time 22.0 days between infusions). The CCR cohort spent a mean of 4.1 days PPPM managing mCSPC, compared to 3.3 days PPPM in the NCR cohort (rate ratio: 1.18; 95% confidence interval [CI]; 1.03, 1.34). Mean all-cause medical and pharmacy costs were $17,833 PPPM in the CCR cohort and $11,527 PPPM in the NCR cohort (weighted adjusted cost difference [CD]: $6,184; 95% CI: 3,515, 8,517). Mean all-cause medical costs were $6,592 PPPM in the CCR cohort and $4,240 PPPM in the NCR cohort (CD [95% CI]: $2,060 [865, 3,369]). Conclusions: In this real world study, patients initiating a CCR experienced greater time toxicity managing mCSPC and higher healthcare costs than those initiating an NCR. Counseling expressing these differences in burden should be included in decision-making conversations when selecting treatment for mCSPC.