Utilization, healthcare expenditures, and patient costs of definitive treatment modalities for localized prostate cancer in the United States.

Abstract

370 Background: Radical prostatectomy (RP) and radiotherapy are standard-of-care treatments for localized prostate cancer. We studied the contemporary trends in utilization and costs of prostatectomy and radiotherapeutic modalities in the U.S. Methods: We analyzed the MarketScan Medicare Supplemental and Coordination of Benefits (MDCR) and Commercial Claims and Encounters (CCAE) Databases (the latter includes patients insured by employer-sponsored plans). We identified men with non-metastatic prostate cancer treated with RP, external beam radiation therapy (EBRT), brachytherapy (BT), EBRT combined with BT (EBRT+BT), stereotactic body radiation therapy (SBRT), or proton beam therapy (PBT) between 2009 and 2021. Year-to-year utilization of each treatment was compared using Kendall’s Tau-b test. Total healthcare and patient out-of-pocket payments within 12 months following treatment initiation were compared among treatment modalities using the Kruskal-Wallis test. Results: In MDCR, we identified 44,937 patients who received treatment with either RP (n=12,879), EBRT (n=26,193), BT (n=926), EBRT+BT (n=4,706), PBT (n=57), or SBRT (n=176). Between 2009 and 2021, the proportion of patients treated with EBRT increased from 52.5% to 62.2% (trend p<0.001), SBRT increased from 0.4% to 0.5% (p<0.001), BT decreased from 3.1% to 1.0% (p<0.001), and EBRT+BT decreased from 14.8% to 6.8% (p<0.001). There was no significant difference in the proportion of patients treated with RP (29.1% vs 29.4%; p=0.82) or PBT (0.1% vs 0.1%; p=0.93). In CCAE, we identified 75,626 patients treated with either RP (n=50,278), EBRT (n=16,985), BT (n=1,243), EBRT+BT (n=6,811), PBT (n=91), or SBRT (n=217). EBRT increased from 20.0% to 24.9% (p<0.001), SBRT increased from 0.1% to 0.8% (p<0.001), BT decreased from 2.5% to 0.7% (p<0.001), and EBRT+BT decreased from 10.6% to 7.4% (p<0.001). There was no significant difference in the proportion of patients treated with RP (66.8% to 66.1%; p= 0.82) or PBT (0.1% vs 0.1%; p=0.76). In both cohorts, PBT had the highest 12-month total and patient costs, while BT had the lowest total cost and SBRT had the lowest patient cost (Table). Conclusions: There is increasing use of EBRT and SBRT in the US. Despite BT being the least costly, its utilization, alone or in combination with EBRT, has declined. Distribution of inflation-adjusted total payments 12 months post diagnosis. Payment MDCR CCAE RP EBRT BT EBRT+ BT PBT SBRT P RP EBRT BT EBRT+ BT PBT SBRT P Total ($) Mean (STD) 30,149 (9,217) 56,199 (19,551) 26,241 (7,920) 38,676 (11,089) 69,719 (17,998) 47,861 (17,377) < 0.001 35,175 (4,800) 66,940 (11,397) 27,377 (3,707) 45,875 (6,620) 102,312 (12,090) 52,544 (8,027) <0.001 Patient ($) Mean (STD) 1,102 (255) 1,285 (294) 1,048 (231) 1,287 (299) 1,044 (237) 992 (325) <0.001 1,965 (671) 1,786 (636) 1,554 (569) 2,031 (695) 1,466 (477) 1,524 (536) <0.001