Costs and Healthcare Resource Utilization Associated with Hospital Admissions of Patients with Metastatic or Nonmetastatic Prostate Cancer.

Abstract

Background: Limited published information exists that compares the costs of metastatic prostate cancer with nonmetastatic prostate cancer. Although most research has focused on the costs of metastatic prostate cancer, delaying metastases in patients with nonmetastatic prostate cancer can reduce or delay healthcare resource utilization and any associated expenditures.

Objective: To compare the costs and healthcare resource utilization of patients with metastatic or nonmetastatic prostate cancer who were receiving care in an inpatient or an outpatient hospital setting.

Methods: Claims from between June 2010 and September 2016 of patients with metastatic or nonmetastatic prostate cancer were retrospectively identified from the Premier Healthcare Database. Patients with a primary diagnosis of malignant neoplasm of the prostate in the inpatient or outpatient setting during the study period were included. Admissions were categorized as metastatic or nonmetastatic prostate cancer based on the presence or absence of an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and/or ICD-10-CM code for metastatic prostate cancer on discharge. Patients with a secondary diagnosis of distant skeletal, lymph node, or visceral metastasis or who received ≥1 treatments indicative of bone metastasis on the same admission were considered to have metastatic prostate cancer.

Results: The study included prostate cancer admissions totaling 78,667 inpatient (4576 with metastatic disease) and 874,366 outpatient (71,545 with metastatic disease) admissions. Among the metastatic prostate cancer inpatient admissions, 72.6% of the patients were aged ≥65 years (mean age, 72 years for metastatic disease vs 63 years for nonmetastatic disease) and approximately 77.5% of these patients had bone metastases. The mean total cost per inpatient admission was $12,324 (standard deviation [SD], $13,506) for metastatic prostate cancer versus $10,987 (SD, $6912) for nonmetastatic disease. The mean total cost per outpatient admission was $1627 (SD, $6182) for metastatic versus $909 (SD, $3458) for nonmetastatic prostate cancer.

Conclusions: The results of this study demonstrate the increased economic burden associated with hospital admissions, particularly inpatient admissions, for patients with metastases compared with patients without metastases. In addition to the clinical burden on patients, these findings further highlight the importance of implementing treatment strategies that can delay progression to metastatic prostate cancer and subsequent increases in healthcare resource utilization and cost.