title: The Clinical and Economic Impacts of Skeletal-Related Events Among Medicare Enrollees With Prostate Cancer Metastatic to Bone.
abstract: BACKGROUND
  Approximately 40% of men diagnosed with metastatic prostate cancer experience one or more skeletal-related events (SREs), defined as a pathological fracture, spinal cord compression, or surgery or radiotherapy to the bone. Accurate assessment of their effect on survival, health care resource utilization (HCRU), and cost may elucidate the value of interventions to prevent SREs.
  
  
  METHODS
  Men older than age 65 years with prostate cancer and bone metastasis diagnosed between 2004 and 2009 were identified from linked Surveillance Epidemiology and End Results-Medicare records. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk for death associated with SREs were calculated by using Cox regression. HCRU and costs (in 2013 U.S. dollars) were evaluated in a propensity score-matched cohort by using Poisson regression and Kaplan-Meier sample average estimators, respectively.
  
  
  RESULTS
  Among 3,297 men with prostate cancer metastatic to bone, 40% experienced ≥1 SRE (median follow-up, 19 months). Compared with men who remained SRE-free, men with ≥1 SRE had a twofold higher risk for death (HR, 2.29; 95% CI, 2.09-2.51). Pathological fracture was associated with the highest risk for death (HR, 2.77; 95% CI, 2.38-3.23). Among men with ≥1 SRE, emergency department visits were twice as frequent (95% CI, 1.77-2.28) and hospitalizations were nearly four times as frequent (95% CI, 3.20-4.40). The attributable cost of ≥1 SRE was $21,191 (≥1 SRE: $72,454 [95% CI, $67,362-$76,958]; SRE-free: $51,263 [95% CI, $45,439-$56,100]).
  
  
  CONCLUSIONS
  Among men with prostate cancer metastatic to bone, experiencing ≥1 SRE is associated with poorer survival, increased HCRU, and increased costs. These negative effects emphasize the importance of SRE prevention in this population.
authors: Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, Washington, USA Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA jamcdoug@fhcrc.org.
authors: Jean A
authors: JA
authors: McDougall
authors: Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, Washington, USA Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
authors: Aasthaa
authors: A
authors: Bansal
authors: Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, Washington, USA Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
authors: Bernardo H L
authors: BH
authors: Goulart
authors: Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, Washington, USA Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
authors: Jeannine S
authors: JS
authors: McCune
authors: Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
authors: Andy
authors: A
authors: Karnopp
authors: Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
authors: Catherine
authors: C
authors: Fedorenko
authors: Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
authors: Stuart
authors: S
authors: Greenlee
authors: Bayer Healthcare Inc., Whippany, New Jersey, USA.
authors: Adriana
authors: A
authors: Valderrama
authors: Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, Washington, USA Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
authors: Sean D
authors: SD
authors: Sullivan
authors: Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, Washington, USA Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
authors: Scott D
authors: SD
authors: Ramsey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000191:economics* / Q000401:mortality / Q000556:secondary*; D005598:Fractures, Spontaneous; D017048:Health Care Costs; D006801:Humans; D008297:Male; D009141:Musculoskeletal System / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000191:economics* / Q000401:mortality / Q000473:pathology*; D018426:SEER Program / Q000706:statistics & numerical data; D013117:Spinal Cord Compression; D014481:United States
keywords: Bone; Bone fractures; Cancer of the prostate; Extramedullary spinal cord compression; Metastasis; Neoplasm metastases; Prostate Cancer; Prostate neoplasms