Health care cost associated with prostate cancer, androgen deprivation therapy and bone complications.
OBJECTIVE
We ascertained the health care costs of androgen deprivation therapy and related skeletal events.


METHODS
Using data from the MarketScan Medicare Supplemental and Coordination of Benefits Database, we identified cases with International Classification of Disease, 9th Revision codes indicating a diagnosis of prostate cancer who initiated androgen deprivation therapy between 1999 and 2002. The control group consisted of patients with prostate cancer with no androgen deprivation therapy use, matched by age, geographic region, insurance plan and index year. All had followup data for at least 36 months. The occurrence and cost of osteoporosis and any bone fracture were assessed using a propensity score matched sample.


RESULTS
Of the 8,577 eligible men with prostate cancer, 3,055 initiated androgen deprivation therapy and 5,522 did not. At the time of androgen deprivation therapy initiation those on androgen deprivation therapy had more severe comorbidity (3.1 vs 2.6, p <0.001) and proportionally more bone metastases (2.8% vs less than 0.6%, p <0.001) but no difference in fracture rate. After 3 years of followup the androgen deprivation therapy group experienced significantly more fractures (18.7% vs 14.6%, p <0.001). The mean unadjusted total cost of health care during the 36-month period was $48,350 per person for cases and $26,097 for controls.


CONCLUSIONS
Among men with prostate cancer, those on androgen deprivation therapy cost the health care system almost twice as much as those not on androgen deprivation therapy. After controlling for differences in health status, the majority of the excess cost is attributable to androgen deprivation therapy and then to a lesser extent, the fractures. These results suggest that the bone complications of osteoporosis and fractures in men on androgen deprivation therapy have important economic consequences.
Krupski
Tracey L
TL
Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27609, USA. krups001@mc.duke.edu
Foley
Kathleen A
KA
Baser
Onur
O
Long
Stacey
S
Macarios
David
D
Litwin
Mark S
MS
D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects; D001859:Bone Neoplasms / Q000188:drug therapy / Q000191:economics / Q000556:secondary; D003365:Costs and Cost Analysis; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous / Q000139:chemically induced / Q000191:economics*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000037:antagonists & inhibitors; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data; D009919:Orchiectomy / Q000191:economics*; D010024:Osteoporosis / Q000139:chemically induced / Q000191:economics*; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000191:economics*; D014481:United States
D000726:Androgen Antagonists; D007987:Gonadotropin-Releasing Hormone