The Economic Burden of Skeletal-Related Events Among Elderly Men with Metastatic Prostate Cancer

Abstract

Metastatic prostate cancer patients with SREs incur higher costs compared to similar patients without SREs. SRE costs among older stage IV (M1) prostate cancer patients vary by SRE type, with spinal cord compression and concurrent surgery costing at least twice as much as other SREs.

The Clinical and Economic Impacts of Skeletal-Related Events Among Medicare Enrollees With Prostate Cancer Metastatic to Bone

“…In addition, this study adds additional information about the incremental risk for death associated with an SRE to the work of Sathiakumar et al That study used similar statistical methods to investigate a related scientific question about the risk for death associated with bone metastasis and SRE together compared with the risk for death in prostate cancer patients without bone metastasis or SREs [10]. Similar to previous studies, our study found that patients with SREs had a higher rate of HCRU and costs than their matched SRE-free counterparts [5,6,14,15]. Previous studies demonstrated that the main driver of costs is the high rate of hospitalizations among SRE patients [5,14].…”

“…Abbreviation: SRE, skeletal-related event. use of a hierarchy is similar to the approach in previous studies [5,14,15], we used a 60-day time window to define unique SRE episodes, whereas other studies have used 30-day and 90-day time windows. Our sensitivity analysis suggests that a 60-day window does not substantially affect the number of SREs counted from claims data.…”

“…In addition, a sensitivity analysis enumerating claims using a 90-day time window was performed. Similar to previous studies, when multiple SRE claims occurred within the defined time window, a hierarchy based on clinical severitywasusedtoclassifythetypeofSREasfollows:(a)spinalcord compression, (b) pathological fracture, (c) surgery to the bone, and (d)radiotherapytobonemetastasis [5,14,15].Asingledatemarking theSREepisodewascreatedonthebasisofthedateofthefirstclaim for the SRE event used to define the SRE episode type.…”

“…SREs represent a substantial challenge in the management of metastatic prostate cancer given their association with high morbidity [11], reduced quality of life [12,13], high health care resource utilization (HCRU) and costs [5,6,14,15], and lower survival [10]. In an analysis of Surveillance Epidemiology and End Results (SEER)-Medicare linked records of 126,978 men with prostate cancer, Sathiakumar et al reported that patients with bone metastasis who experienced an SRE had a 10-fold higher risk for death than patients without bone metastasis or an SRE (adjusted hazard ratio [HR] for mortality, 10.2; 95% confidence interval [CI], 9.8-10.7) [10].…”

Pathologic fracture in patients with metastatic prostate cancer

“…To illustrate this, consider that in the clinical trial comparing zoledronic acid with placebo for prevention of SREs in mCRPC (protocol 039), 49% of patients in the placebo group and 38% of patients in the zoledronic acid group had at least one SRE (P ¼ 0.028) [3]. SREs are associated with important consequences, including significant cost [4], decreased quality of life [5,6] and decreased survival [6]. A number of prognostic variables for SRE risk have been reported.…”