Direct Medical Costs (DMC) of Treating Prostate Cancer in a Medical Cooperative Hmo in Brazil: Results From a Longitudinal Analysis of an Administrative Database

Abstract

Objectives: The aim of this study is to determine direct medical costs of treating patients with prostate cancer from the perspective of a Brazilian HMO. Methods: An administrative database containing inpatient and outpatient claims of Unimed São Jose do Rio Preto, a HMO in São Paulo state with 131,064 beneficiaries, was reviewed from Jan/2004 to Dec/2013. Eligibility criteria were patients with a medical claim associated with prostate cancer (ICD-10 code C61) from Jun/2012 to Dec/2012, with more than 30-days of follow-up data. Diagnosis date for these patients were ascertained and they were followed until death or loss of follow-up, whichever comes first. Outcome was direct medical costs (DMC), calculated as the sum of the medical claims for each patient included in the analysis. DMC-per-year associated with prostate cancer was calculated and stratified by treatment choice (wait-andsee, local therapy, androgen deprivation, chemotherapy). Results: 312 patients met eligibility criteria, with a median follow-up of 2.94 years. Total DMC in this population was R$ 4,247,664.42, from which R$ 1,675,255.31 (39.4%) are related to diagnostic exams, R$ 792,795.52 (18.7%) to hospitalizations, R$ 615,164.85 (14.5%) to radiotherapy, R$ 333,388.04 (7.8%) to chemotherapy and R$ 831,060.70 (19.6%) to other outpatient costs. A total of 143 patients started treatment as wait-and-see with average DMC-per-year related to prostate cancer of R$ 432.44/year; for patients starting local therapy, there were 162 patients with average DMC-per-year of R$ 4,640.95/year; the androgen deprivation group had 19 patients with average DMCper- year of R$ 5.850,15/year and 4 patients started chemotherapy with an average DMC-per-year of R$ 33.773,22/year. Conclusions: Patients with prostate cancer represent a significant economic burden to private payers, escalating as disease progresses. Patients starting chemotherapy may cost per year approximately 6 times the cost of patients in early stages of the disease.