title: The burden of skeletal-related events in patients with prostate cancer and bone metastasis.
abstract: BACKGROUND
  To assess contemporary characteristics, hospital admissions, charges, and mortality in patients with prostate cancer (CaP) who have bone metastases and skeletal-related events in an observational study.
  
  
  METHODS
  Relying on the Nationwide Inpatient Sample (NIS), patients with CaP with bone metastases between 1998 and 2010 were abstracted. Patients who experienced skeletal-related events were identified, and hospital charges were calculated. Generalized linear regression analyses focused on in-hospital mortality.
  
  
  RESULTS
  Between 1998 and 2010, a weighted estimate of 443,929 CaP visits with bone metastases was recorded. Of these, 15.9% experienced at least 1 SRE. The rate of SRE decreased from 18% to 15.4% (1998-2010, estimated annual percent change [EAPC] =-1.44%, P = 0.005) and the SRE-associated mortality decreased from 8.5% to 4.7% (1998-2010, EAPC =-3.68%, P = 0.004). Nevertheless, the inflation-adjusted charges associated with hospital visits of patients with CaP with bone metastases rose by 92% to $1,512,449,106 (EAPC = +8.82%, P<0.001), and SRE charges rose by 94% to $369,256,799 (EAPC =+7.62%, P<0.001). Predictors of in-hospital mortality in patients with SRE included age (odds ratio [OR] = 1.02), comorbidities (≥3 vs. 0-1, OR = 1.72), SRE of the upper limb (OR = 1.75), SRE of the lower limb (OR = 1.35), spinal cord compression (OR = 1.48), radiation (OR = 0.68), surgery (OR = 0.32), and year of hospitalization (2010 vs. 1998, OR = 0.54; all P< 0.03).
  
  
  CONCLUSIONS
  From 1998 to 2010, the incidence of SRE and SRE-associated mortality in patients with CaP and bone metastases decreased. However, charges for SRE-associated hospitalizations have increased alarmingly. Future health care policies should strive to provide cost-effective prevention and management of SREs in this population.
authors.affiliation: Department of Urology, Ruhr University Bochum, Marien Hospital, Herne, Germany. Electronic address: f.roghmann@gmail.com.
authors.forename: Florian
authors.initials: F
authors.lastname: Roghmann
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada.
authors.forename: Carina
authors.initials: C
authors.lastname: Antczak
authors.affiliation: Department of Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
authors.forename: Rana R
authors.initials: RR
authors.lastname: McKay
authors.affiliation: Department of Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
authors.forename: Toni
authors.initials: T
authors.lastname: Choueiri
authors.affiliation: Department of Urology, University of California (UCLA), Los Angeles, CA.
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
authors.affiliation: Division of Urologic Surgery and Center for Surgery and Public Health, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kibel
authors.affiliation: Department of Urology, Yale School of Medicine, New Haven, CT.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kim
authors.affiliation: Department of Urology, Georgetown University Hospital, Washington, DC.
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Kowalczyk
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.affiliation: CRCHUM, Centre Hospitalier de l׳Université de Montréal, Montreal, Québec, Canada.
authors.forename: Fred
authors.initials: F
authors.lastname: Saad
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.affiliation: Division of Urologic Surgery and Center for Surgery and Public Health, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
authors.forename: Marianne
authors.initials: M
authors.lastname: Schmid
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, MN.
authors.forename: Shyam
authors.initials: S
authors.lastname: Sukumar
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada.
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.affiliation: Department of Urology, Ruhr University Bochum, Marien Hospital, Herne, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Noldus
authors.affiliation: Division of Urologic Surgery and Center for Surgery and Public Health, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
mesh_terms: D000368:Aged; D001859:Bone Neoplasms / Q000556:secondary*; D017281:Cost of Illness; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011471:Prostatic Neoplasms / Q000473:pathology*; D064129:Prostatic Neoplasms, Castration-Resistant / Q000473:pathology
keywords: Charges; Mortality; NIS; Prostate cancer; Skeletal-related event