title: Burden of illness of bone metastases in prostate cancer patients in Québec, Canada: A population-based analysis.
abstract: BACKGROUND
  Metastasis of prostate cancer (PC) to bone (metastatic bone disease, MBD) increases morbidity, but Canadian data are lacking on the associated healthcare resource utilization (HCRU) and costs. We quantified MBD-related HCRU and associated costs in this population, and assessed skeletal-related events (SREs), such as pathologic fracture, spinal cord compression, bone radiotherapy, and bone surgery.
  
  
  METHODS
  We conducted a retrospective, population-based cohort study using the Québec health insurance agency database. Prescription drug and medical services data were retrieved for patients with ≥1 healthcare claim in 2001 with a PC diagnosis (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] code of 185.xx). Patients with ≥2 MBD-related claims or an SRE were compared with a matched-control group of PC patients without MBD. Patients were followed until death, loss to follow-up, or the end of available data (August 31, 2010). Costs (in 2012 Canadian dollars) were adjusted for age, year of MBD diagnosis, general health status, and baseline resource utilization.
  
  
  RESULTS
  Compared with controls (n = 1671), MBD patients (n = 626) had significantly higher HCRU. Adjusted mean (95% confidence interval) all-cause healthcare costs were $11 820 (7248-16 058) higher, and MBD-related costs were $3 091 (1267-4861) higher in MBD patients than in controls. Nearly 50% of MBD patients received radiotherapy within 2.5 years of their MBD diagnosis, but most exited the study without experiencing other SREs.
  
  
  CONCLUSIONS
  MBD imposes a heavy HCRU and cost burden among patients with PC in Canada. Effective therapy is needed to reduce the clinical and economic impact of MBD in this population.
authors.affiliation: International Market Access Consulting, Switzerland;
authors.forename: Louise
authors.initials: L
authors.lastname: Perrault
authors.affiliation: Centre de Recherche du CHU de Québec, QC;
authors.forename: Vincent
authors.initials: V
authors.lastname: Fradet
authors.affiliation: International Market Access Consulting, Switzerland;
authors.forename: Véronique
authors.initials: V
authors.lastname: Lauzon
authors.affiliation: Centre Hospitalier de l'Université de Montréal, QC;
authors.forename: Jacques
authors.initials: J
authors.lastname: LeLorier
authors.affiliation: International Market Access Consulting, Switzerland;
authors.forename: Dominic
authors.initials: D
authors.lastname: Mitchell
authors.affiliation: Amgen Canada Inc, ON.
authors.forename: Mohdhar
authors.initials: M
authors.lastname: Habib