Utilization, health care expenditures, and patient costs of definitive treatment modalities for localized prostate cancer in the United States

Abstract

Background

Radical prostatectomy (RP) and radiotherapy (RT) are standard-of-care treatments for localized prostate cancer. The authors studied the utilization and total health care and patient-incurred costs of RP and RT in the United States using the Merative MarketScan Medicare (Medicare Supplemental and Coordination of Benefits [MDCR]) and Commercial (Commercial Claims and Encounters [CCAE]) databases.

Methods

Men were identified who had nonmetastatic prostate cancer treated with RP, external-beam RT (EBRT), brachytherapy (BT), EBRT combined with BT (EBRT + BT), stereotactic body RT (SBRT), or proton-beam therapy (PBT) between 2009 and 2022. Year-to-year treatment utilization was compared using the Kendall Tau-b test. Mean total health care and patient out-of-pocket costs within 12 months of treatment were compared using the Kruskal–Wallis test.

Results

In the MDCR database, 44,937 patients were identified who received treatment with RP (n = 12,879), EBRT (n = 26,193), BT (n = 926), EBRT + BT (n = 4706), PBT (n = 57), or SBRT (n = 176). Between 2009 and 2021, EBRT use increased from 52.5% to 62.2% (p for trend < .001), SBRT increased from 0.4% to 0.5% (p < .001), BT decreased from 3.1% to 1.0% (p < .001), and EBRT + BT decreased from 14.8% to 6.8% (p < 0.001); whereas use remained similar for RP (from 29.1% to 29.4%; p = .82) and PBT (from 0.1% to 0.1%; p = .93). In the CCAE database, 75,626 patients were identified who received treatment with RP (n = 50,278), EBRT (n = 16,985), BT (n = 1243), EBRT + BT (n = 6811), PBT (n = 92), or SBRT (n = 217). EBRT use increased from 20.0% to 24.9% (p < .001), SBRT increased from 0.1% to 0.8% (p < .001), BT decreased from 2.5% to 0.7% (p < .001), and EBRT + BT decreased from 10.6% to 7.4% (p < .001); whereas use remained similar for RP (from 66.8% to 66.1%; p for trend = .82), and PBT (from 0.1% to 0.1%; p for trend = .76). In the MDCR and CCAE databases, PBT had the highest total cost, whereas BT had the lowest.

Conclusions

Between 2009 and 2021, there was increasing use of EBRT and SBRT, whereas use of RP remained stable. Although BT was the least costly, its utilization as monotherapy and combined with EBRT declined.