MP41-20 DISEASE-SPECIFIC COSTS OF NONMETASTATIC AND METASTATIC CASTRATION-RESISTANT PROSTATE CANCER IN QUEBEC

Abstract

INTRODUCTION AND OBJECTIVES: Prostate cancer (PCa) accounts for 10% of all cancers diagnosed in Canada and 21% (21,300 new cases) of cancers among males. Androgen deprivation therapy (ADT) is a very effective strategy of managing PCa. However nearly all men will develop castration-resistant disease and the majority of men who die from PCa experienced a progression to metastatic disease. Estimate the disease specific costs of PCa patients during the health states of nonmetastatic castration-resistant prostate cancer (NMCRPC) and metastatic castration-resistant prostate cancer (M-CRPC). METHOD(S): This cohort analysis contains 211 PCa patients from the McGill University Health Centre (MUHC) that were selected retrospectively through the period from 2000 to the end of 2015. The patients were followed from diagnosis of PCa until death or until the end of 2016. An algorithm to detect NM-CRPC and M-CRPC was based on increases of prostate specific antigen (PSA) levels after castration and the detection of metastasis. Consecutively, the mean time per health state was identified. The usage of imaging tests, hospital visits and treatments were extracted from the patients' medical charts and the mean usage per resource was calculated for 30 days in the given health state. Resource costs were obtained from the Regie de l'assurance maladie du Quebec List of Medications when available; when unavailable prices were obtained from the MUHC internal prices lists. This cost analysis was performed from the health care system perspective. RESULT(S): Mean duration of NM-CRPC was 26.07 months while duration of M-CRPC was 20.79 months, with 62 and 68 patients per health state respectfully. The average cost for PCa-specific resources per 30 days was $786 for NM-CRPC and $2,210 for MCRPC health states with the cost driver being chemotherapy or prescription drugs other than ADT. The resource utilization that increased the most from NM-CRPC to M-CRPC was emergency visits (increased 26 times), while costs for ADT, chemotherapy or prescription drugs other than ADT and radiotherapy increased by more than twofold. The total average cost for NM-CRPC health state was $20,457 compared to $45,956 for M-CRPC health state. CONCLUSION(S): The disease specific resource utilization costs for a patient in M-CRPC are significantly higher than the costs of NM-CRPC. The overall cost of these phases of PCa should be even higher as the present study captured only costs for resources recorded in medical health records.