Research

The impact of bone metastases and skeletal-related events on healthcare costs in prostate cancer patients receiving hormonal therapy

Although studies have examined the effect of skeletal-related events (SREs) on healthcare costs in patients with advanced cancer and bone metastases, the effect of bone metastases without SREs on costs has not been studied. To estimate the effects of bone metastases with and without SREs on healthcare costs in men with prostate cancer treated with hormonal therapies, we performed a retrospective cohort study using claims data from large, US health insurance plans between September 2002 and May 2008. The primary measure was total healthcare costs after bone metastases. Secondary measures included components of total healthcare costs and selected measures of healthcare utilization. Of 215,702 patients with prostate cancer, 8,608 had bone metastases, and 1,365 met all inclusion criteria, with 786 (58%) reporting ≥ 1 SRE and 579 (42%) reporting no SRE. The mean duration of follow-up was 14 months. The mean total healthcare costs were $23,047/person-year in the 6 months before bone metastases. After adjustment, the costs increased by $12,780/person-year with bone metastases and no SREs (P



 

Bone is the most common site of metastases in men with advanced prostate cancer, one of the most prevalent cancers in the United States and the second leading cause of cancer death after lung cancer.1–3 The median survival from diagnosis of bone metastases is 30–40 months.2 During this time, skeletal-related events (SREs), including pathologic fractures, surgery or radiation to the bone, spinal cord compression, or hypercalcemia of malignancy, can occur. SREs are associated with considerable morbidity, impaired health-related quality of life, reduced survival, and increased costs.4–10


Although studies have examined the impact of SREs on costs in patients with advanced cancers and bone metastases,5–9,11 the effects of bone metastases without SREs on healthcare costs in prostate cancer patients have not been studied. The magnitude of these costs may be important in economic evaluations of treatments to prevent or delay bone metastases in prostate cancer patients. The objective of this study was to estimate the effects on healthcare costs of bone metastases in the presence and absence of SREs in men with prostate cancer who were receiving hormonal therapy.

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