Health Care Cost Associated With Prostate Cancer, Androgen Deprivation Therapy And Bone Complications

Main Category: Prostate / Prostate Cancer
Also Included In: Men's health;  Bones / Orthopaedics;  Clinical Trials / Drug Trials
Article Date: 02 Dec 2007 - 0:00 PST

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UroToday.com- One-third of men diagnosed with prostate cancer (CaP) will eventually undergo androgen deprivation therapy (ADT). In the October 2007 issue of the Journal of Urology, Dr. Krupski and associates of Dr. Mark Litwin report that men on ADT experience bone complications of osteoporosis and fractures ten increased health care costs.

The researchers used the MarketScan Medicare Supplemental and Coordination of Benefits Database to asses the inpatient, outpatient, and outpatient prescription drug experiences of patients with prostate cancer (CaP). Patients with an ICD-9 code for CaP and at least one drug claims for an LH-RH agonist or bilateral orchiectomy were identified. Men with CaP but not receiving an LH-RH agonist were matched as controls. Osteoporosis was defined by either a claim with a diagnosis of osteoporosis, a drug claim for an osteoporosis medication not considered a bisphosphonates, or any bisphosphonate.

Of 50,980 men identified with CaP between 1998 and 2004, 34.8% had received ADT at some time point. The ADT group compared to controls had a higher comorbidity index and higher total medical costs. Rates of bone metastasis increased and remained higher for the ADT group. All indicators for bone density loss significantly worsened in the ADT patients relative to controls. This included osteoporosis, osteoporosis medication, bisphosphonate use, and bone fracture. Any use of ADT increased the odds of fracture. Total health care costs during the 36-month period were $29,044. Multivariate analysis revealed that fracture and ADT increased this cost by $14,061 and $25,796, respectively. A total of 18% of men in the study cohort on ADT sustained a fracture compared with 14% of controls. The 3-year adjusted total health care costs for men on ADT were $48,350 compared to $26,097 for controls.

Krupski TL, Foley KA, Baser O, Long S, Macarios D, Litwin MS

J Urol. 178(4): 1423- 1428, October 2007
doi:10.1016/j.juro.2007.05.135

Reported by UroToday.com Contributing Editor Christopher P. Evans, M.D

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