Health Care Costs Attributable to Prostate Cancer in British Columbia, Canada: A Population-Based Cohort Study

Abstract

We aimed to estimate the total health care costs attributable to prostate cancer (PCa) during care phases by age, cancer stage, tumor grade, and primary treatment in the first year in British Columbia (BC), Canada. Using linked administrative health data, we followed a cohort of men aged ≥ 50 years at diagnosis with PCa between 2010 and 2017 (Cohort 1) from the diagnosis date until the date of death, the last date of observation, or 31 December 2019. Patients who died from PCa after 1 January 2010, were selected for Cohort 2. PCa attributable costs were estimated by comparing costs in patients to matched controls. Cohort 1 (n = 22,672) had a mean age of 69.9 years (SD = 8.9) and a median follow-up time of 5.2 years. Cohort 2 included 6942 patients. Mean PCa attributable costs were the highest during the first year after diagnosis ($14,307.9 [95% CI: $13,970.0, $14,645.8]) and the year before death ($9959.7 [$8738.8, $11,181.0]). Primary treatment with radiation therapy had significantly higher costs each year after diagnosis than a radical prostatectomy or other surgeries in advanced-stage PCa. Androgen deprivation therapy (and/or chemotherapy) had the highest cost for high-grade and early-stage cancer during the three years after diagnosis. No treatment group had the lowest cost. Updated cost estimates could inform economic evaluations and decision-making.

Economic evaluation of prostate cancer risk assessment methods: A cost‐effectiveness analysis using population data

“…We also created a cohort of PCa patients who were diagnosed with PCa after 1997 and died from PCa after 2010 (Cohort 2 “cases”) to facilitate the estimation of healthcare costs for the year before death. Controls who were No‐PCa individuals from the BC general population were matched to the cases in each cohort; details on matching are described in the Method S1 and our previous study 37 . The study was approved by the behavioral research ethics board of the University of British Columbia (H20‐01258).…”

“…For each PCa grade and treatment pathway, incremental costs attributable to PCa (difference in the total healthcare costs between the cases and matched controls) were estimated for the first year after the diagnosis, the second year, every year from the third year until 1 year before death (based on Cohort 1 and their controls), and 1 year before death (Cohort 2 and their controls) 37 . The incremental costs in these four time intervals were considered as costs attributable to PCa and included the incremental costs related to diagnostic tests and treatments incurred by the patients in each specific health state in the first year and beyond the first year 37 . Figure S2 presents the mean annual incremental cost over time and supports the choice of modeling of the incremental cost by the time intervals.…”

“…37 The incremental costs in these four time intervals were considered as costs attributable to PCa and included the incremental costs related to diagnostic tests and treatments incurred by the patients in each specific health state in the first year and beyond the first year. 37 Figure S2 presents the mean annual incremental cost over time and supports the choice of modeling of the incremental cost by the time intervals. All costs were in 2021 Canadian dollars.…”

“…Controls who were No-PCa individuals from the BC general population were matched to the cases in each cohort; details on matching are described in the Method S1 and our previous study. 37 The study was a Numbers in parentheses represent the mean and standard deviation for the normal distribution, and the shape and scale for the gamma distribution.…”