Costs of managing castrate-resistant metastatic prostate cancer patients at Inkosi Albert Luthuli Central Hospital

Abstract

Background: Metastatic castration-resistant prostate cancer (mCRPC) has a five-year survival rate of 30% despite the availability of expensive therapeutic agents. This study investigated the costs to a tertiary public hospital of the management of mCRPC with various therapeutic agents. Methods: Between 1 January 2017 and 24 November 2019 the records of patients who were diagnosed with mCRPC and received chemotherapy (docetaxel) in combination with goserelin (a luteinising hormone-releasing hormone [LHRH]), or bicalutemide (an anti-androgen) at the Inkosi Albert Luthuli Central Hospital were analysed. The activity-based costing (ABC) model was used to calculate the medicine costs and other expenses incurred by the hospital. Results: During the study period, 64 patients, mean age 66 years (± 8.7) at first visit, met the inclusion criteria of this study. The total cost incurred by the hospital was R10 338 559. On average, a total of R161 540 (SEM R22 699.00) per patient was incurred by the hospital. There was 60% reduction (p = 0.01), after the average period of 4 months (± 2.9), in PSA levels in patients who received goserelin monotherapy. Conclusion: The therapeutic gain from extremely expensive therapy in mCRPC patients requires evaluation of clinical response and survival data to justify the expense.