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Clinical Review Abstract

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Incremental cost (IC) analysis of skeletal related events (SREs) among elderly men with stage IV metastatic (M1) prostate cancer (PCa).

Prostate Cancer

Genitourinary (Prostate) Cancer

2013 ASCO Annual Meeting

Abstract No:

J Clin Oncol 31, 2013 (suppl; abstr e16034)

Publication-only abstracts (abstract number preceded by an "e"), published in conjunction with the 2013 Annual Meeting but not presented at the Meeting, can be found online only.

Author(s): Jinani Jayasekera, Ebere Onukwugha, Kaloyan A. Bikov, C. Daniel Mullins, Brian S. Seal, Arif Hussain; School of Pharmacy, University of Maryland, Baltimore, MD; University of Maryland School of Pharmacy, Baltimore, MD; Bayer HealthCare Pharmaceuticals, Wayne, NJ; University of Maryland School of Medicine, Baltimore, MD

Abstract Disclosures


Background: Patients diagnosed with stage IV M1PCa are predisposed to SREs, such as pathologic fracture (PF), spinal cord compression (SCC) and bone surgery (BS). There is limited information in the literature regarding the ICs associated with SREs among stage IV M1 PCa patients. Methods: We analyzed patients aged 66+ yrs diagnosed with incident stage IV M1 PCa between 2000 and 2007 from the linked SEER-Medicare dataset. Five mutually exclusive SRE categories were created: PF only, PF+concurrent surgery (SRG), SCC only, SCC+SRG, and BS only. Patients with multiple SREs were excluded. A propensity score for the incidence of an SRE was estimated using a logistic regression model including baseline demographic and clinical variables, diagnosis year and SEER region. Patients with SREs (cases) were matched to those without SREs (controls), based on the propensity score. The date of SRE of a case was assigned to a matched control, and the 12 month pre- and post-SRE costs were calculated. A difference-in-difference method was used to estimate the ICs (post-pre) for cases vs. controls. The analysis was conducted from a US Medicare perspective. Results: Application of inclusion criteria resulted in 1,131 stage IV M1 PCa patients with SREs. The average age was 78 yrs and 12% were African American. Using the propensity score, 1,031 cases were matched with 1,031 controls and allocated to the following SRE groups: PF+SRG (n=134), PF only (n=143), SCC+SRG (n=40), SCC only (n=538) and BS only (n=176). The average IC per SRE was $30,548 (vs. controls). The most expensive SRE group was SCC+SRG with a total average IC of $62,412, followed by BS only ($37,554), PF+SRG ($35,520), SCC ($28,027), and PF only ($17,839). Inpatient costs were the major driver of ICs followed by physician/non-institutional provider and skilled nursing facility (SNF) costs. Conclusions: The ICs associated with an SRE are significant. The IC of an SRE varies by type of SRE and service category.

Incremental costs (US $)
Inpatient Provider SNF Outpatient Other
SCC+SRG 35,479 13,473 5,523 2,613 5,324
SCC only 12,864 5,667 3,305 1,077 5,114
PF+SRG 17,114 5,616 6,224 705 5,861
PF only 5,531 3,794 2,319 1,256 4,939
BS 18,205 4,923 7,284 1,102 6,040


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