Direct and Indirect Costs of Prostate Cancer: A Comprehensive Assessment of Economic and Social Impact

Advanced Prostate Cancer: AUA/ASTRO/SUO Guideline PART II.

Metastatic Burden in Hormone-Naive Prostate Cancer: A Tale of Two Subgroups

Targeting Metastatic Hormone Sensitive Prostate Cancer: Chemohormonal Therapy and New Combinatorial Approaches.

Clinical and genomic insights into circulating tumor DNA-based alterations across the spectrum of metastatic hormone-sensitive and castrate-resistant prostate cancer

Efficacy of Systemic Treatment in Prostate Cancer Patients With Visceral Metastasis: A Systematic Review, Meta-analysis, and Network Meta-analysis.

To establish a novel quantitative method that automatically excludes the red bone marrow and accurately quantifies the tumor volume on whole-body magnetic resonance imaging using updated imaging software. To also evaluate the association between the quantified tumor volume and the prognosis of patients with metastatic prostate cancer. This prospective analysis included patients diagnosed with metastatic hormone-sensitive or metastatic castration-resistant prostate cancer between 2017 and 2022. We developed an imaging software (Attractive BD_Score) that analyzed whole-body diffusion-weighted and in-phase and opposed-phase T1-weighted images to automatically exclude the red bone marrow. The quantified tumor volume was compared with that quantified by traditional whole-body diffusion-weighted imaging without red bone marrow exclusion. Prostate-specific antigen progression-free survival, time-to-pain progression, and overall survival were evaluated to assess the prognostic value of the quantified tumor volume. The quantified tumor volume was significantly smaller than that quantified by the traditional method in metastatic hormone-sensitive (median: 81.0 ml vs. 149.4ml) and metastatic castration-resistant (median: 29.4 ml vs. 63.5ml) prostate cancer. A highly quantified tumor volume was associated with prostate-specific antigen progression-free survival (p= 0.030), time-to-pain progression (p=0.003), and overall survival (p= 0.005) in patients with metastatic hormone-sensitive prostate cancer and with poor prostate-specific antigen progression-free survival (p= 0.001) and time-to-pain progression (p= 0.005) in patients with metastatic castration-resistant prostate cancer. Our imaging method could accurately quantify the tumor volume in patients with metastatic prostate cancer. The quantified tumor volume can be clinically applied as a new prognostic biomarker for metastatic prostate cancer.

Shifts in migration and border control policies may increase the likelihood of trauma exposure related to child–parent separation and result in costs to the health system and society. In the present study, we estimated direct and indirect costs per child as well as overall cohort costs of border control policies on migrant children and adolescents who were separated from their parents, detained, and placed in the custody of the United States following the implementation of the 2018 Zero Tolerance Policy. Economic modeling techniques, including a Markov process and Monte Carlo simulation, based on data from the National Child Traumatic Stress Network's Core Data Set (N = 458 migrant youth) and published studies were used to estimate economic costs associated with three immigration policies: No Detention, Family Detention, and Zero Tolerance. Clinical evaluation data on mental health symptoms and disorders were used to estimate the initial health state and risks associated with additional trauma exposure for each scenario. The total direct and indirect costs per child were conservatively estimated at $33,008, $33,790, and $34,544 after 5 years for No Detention, Family Detention, and Zero Tolerance, respectively. From a health system perspective, annual estimated spending increases ranged from $1.5 million to $14.9 million for Family Detention and $2.8 million to $29.3 million for Zero Tolerance compared to baseline spending under the No Detention scenario. Border control policies that increase the likelihood of child and adolescent trauma exposure are not only morally troubling but may also create additional economic concerns in the form of direct health care costs and indirect societal costs.

A Cost-effectiveness Analysis of Systemic Therapy for Metastatic Hormone-sensitive Prostate Cancer

324 Background: Androgen deprivation therapy (ADT) remains a standard of care in the treatment of locally advanced prostate cancer. But thanks to a few key trials (STAMPEDE, CHAARTED, and LATITUDE) reported within the past three years, docetaxel and abiraterone now have roles in extending overall survival in a patient population traditionally treated with ADT alone. These treatments when combined with ADT have been shown to extend overall survival in metastatic hormone-sensitive prostate cancer patients. The role of ADT in relation to other therapies continues to evolve rapidly. We intend to revisit ADT’s longstanding role in prostate cancer treatment using a national cancer database. Our aim is to look beyond traditional standards of care to identify patients more likely to have overall survival benefit from ADT. Are there any subgroups of patients with intermediate or high risk disease that have improved survival outcomes with androgen deprivation therapy, besides patients with localized disease that underwent radiation? Could there be other variables besides PSA and localization of the prostate cancer that should be considered when identifying ADT treatment candidates, or identifying survival trends in these groups? Methods: We are currently analyzing variables present in the National Cancer Database to retrospectively identify predictive factors for overall survival and progression to metastatic castrate resistant prostate cancer in locally advanced prostate cancers treated with ADT. We will evaluate time-to-death from the initiation of ADT and from the diagnosis of metastatic castrate resistant prostate cancer. The following variables in localized, locally advanced, and metastatic prostate cancer will be analyzed with Statistical Analysis Software: age, locally advanced, site-specific metastasis (M1a, M1b, M1c), Gleason score, local treatment (radical prostatectomy or radiation), stage (T, N, and M), prostate lobe (one vs. both; T2a/b vs. T2c), chemotherapy (date, time from M1 stage), comorbidity score, ethnicity, facility type, insurance, and risk groups (low/intermediate/high as per NCCN guidelines).

Background. The addition of enzalutamide to standard androgen deprivation therapy (ADT) significantly increases overall survival and progression-free survival in patients with metastatic hormone-sensitive prostate cancer (mHSPC) compared with ADT.Objective: to evaluate the incremental cost/effectiveness ratio (ICER) of enzalutamide use in patients with mHSPC and the ICER of enzalutamide as the first-line therapy for metastatic castration-resistant prostate cancer (mCRPC) from the Russian healthcare system perspective and to assess the contribution of enzalutamide into the reduction of mortality of mHSPC patients in the Russian Federation on the horizon until 2024.Materials and methods. Standard ADT regimens for mHSPC were used as a comparator as it is the most common treatment for mHSPC in Russia. We proposed a Markov model of mHSPC progression on enzalutamide + ADT (hereinafter enzalutamide) or ADT + 1st generation antiandrogen (hereinafter ADT) based on ENZAMET trial data. Model was used to calculate the average life-years gained (LYG) and costs of mHSPC and post-progression mCRPC treatment. Simulation period was 15 years with one cycle of 1 month. In the “cost–effectiveness” analysis, we calculated enzalutamide ICER compared to ADT. In addition, we calculated ICER for enzalutamide plus ADT vs ADT in the first-line therapy of mCRPC as a benchmark based on PREVAIL trial data. In both cases, the average LYG over a 15-year period was used as an efficacy criteria. To assess the contribution of the enzalutamide into the reduction of mortality rate of mHSPC patients, the potential number of patients who could be treated with enzalutamide on the horizon of 2021–2024 was taken into account.Results. According to the Markov model, the average LYG over a period of 15 years for enzalutamide was 7.59 years compared to 5.12 for ADT. The average enzalutamide therapy costs were 11,193,802 rubles per patient for 15 years, which were 8,597,131 rubles higher than when using ADT (2,596,672 rubles). ICER for enzalutamide (vs ADT) in mHSPC treatment was 3,484,362 rubles per one life-year gained. ICER for enzalutamide in the first line of mCRPC treatment (vs ADT) was 5,899,418 rubles per one life-year gained. The combination therapy with enzalutamide + ADT in Russia can be started annually by 2,410 mHSPC patients. If they all receive enzalutamide a total of 561 averted deaths among prostate cancer patients can be expected in 2021–2024.Conclusion. In the Russian healthcare system, ICER for enzalutamide in mHSPC was 3,484,362 rubles and the ICER for enzalutamide in mCRPC was 5,899,418 rubles. Enzalutamide can make a significant contribution to achieving the target cancer mortality rates by 2024.

Second-line treatment options in metastatic castration-resistant prostate cancer: A comparison of key trials with recently approved agents

Efficacy of Enzalutamide plus Androgen Deprivation Therapy in Metastatic Hormone-Sensitive Prostate Cancer by Pattern of Metastatic Spread: ARCHES Post Hoc Analyses.

BackgroundPatients with metastatic castration-resistant prostate cancer (mCRPC) are refractory to immune checkpoint inhibitors (ICIs).1 2 Although prostate cancer is highly populated by multiple immunosuppressive myeloid cells especially after androgen deprivation...

Metastatic prostate cancer management: 20 years of progress

O030 / #400Topic:AS23 - SLE-Diagnosis, Manifestations, & OutcomesABSTRACT CONCURRENT SESSION 05: EMERGING INSIGHTS ON THE MANAGEMENT OF LUPUS MANIFESTATIONS AND COMORBIDITIES23-05-2025 1:40 PM - 2:40 PMBackground/PurposeWe described the direct healthcare costs associated with damage accrual in patients in the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort.[1] However, our estimates only included partial direct costs and indirect costs from lost productivity were not included. We supplemented our primary data by querying a cohort subset on all healthcare use and lost time in paid/unpaid labor and provide estimates of complete direct and indirect costs for the full cohort, stratified by damage.MethodsBetween 1999 and 2011, SLE patients from 31 centers in 10 countries were enrolled into the SLICC Inception Cohort within 15 months of diagnosis and data on disease damage (SLICC/ACR Damage Index [SDI]) and limited healthcare use (ie, hospitalizations, medications, and dialysis) were collected annually through to July 2022. Starting in 2015, 18 sites collected supplemental economic data annually (ie, visits to physicians, nonphysician healthcare professionals, and the emergency room, laboratory tests, radiological/other diagnostic procedures, outpatient surgeries, help obtaining medical care, and lost time in paid/unpaid labor). Direct costs were calculated by multiplying each health resource by its corresponding 2023 Canadian unit cost. Total indirect costs included: 1) absenteeism (time lost from paid labor because of illness), 2) presenteeism (degree of patient self-reported productivity impairment in paid/unpaid labor, based on a visual analog scale), and 3) opportunity costs (additional time patients would be working in paid/unpaid labor if not ill). Opportunity costs were calculated as the difference between the time patients reported working vs that worked by an age, sex, and geographic-matched general population in paid/unpaid labor. Indirect costs from paid/unpaid labor were valued using age-and-sex-specific wages from Statistics Canada. Multiple imputation was used to predict missing cost values for the patients in the full cohort who provided only utilization data for hospitalizations, medications, and dialysis for all observations. At each assessment, patients were assigned to one of 6 damage states (ie, SDI = 0, 1, 2, 3, 4, ≥ 5) and annual costs, both unimputed and including imputations, were stratified by SDI score. Means and 95% confidence intervals were computed and compared.Results1694 patients (88.8% female, 48.9% White, mean age at diagnosis 34.6 years, mean disease duration at cohort enrollment 0.5 years), were followed for a mean of 10.5 (SD 5.3) years. Of these 1694 patients, 766 (89.7% female, 41.4% White, mean age at diagnosis 33.0 years, mean disease duration at cohort enrollment 0.4 years) completed the supplemental economic questionnaire. Their mean disease duration at the time of introduction of the supplemental questionnaire was 10.9 (range 3.9-19.5) years and this cohort subset provided this additional economic data for a mean of 3.5 (SD 1.9) years. Among the cohort subset completing the supplemental economic questionnaire, on average, indirect costs, primarily from unpaid labor, accounted for 81.1% of total costs (Table 1). For the full cohort, annual direct and indirect costs increased with increasing SDI (SDI=0: total costs $33,812 [95% CI $31,088, $36,537]; SDI ≥ 5: total costs $90,839 [95% CI $82,275, $99,403]) (Table 2).Table 1.Annual complete direct, indirect, and total costs (in 2023 Canadian dollars) for the cohort subset providing complete cost data, stratified by SDI (n = 2414 observations). Values are means.Table 2.Annual imputed complete direct, indirect, and total costs (in 2023 Canadian dollars) for the full cohort, stratified by SDI (n = 15,106 observations).ConclusionsPatients with the highest vs the lowest SDIs incurred complete direct costs that were 5.9-fold higher and indirect costs 2.1-fold higher. However, patients with no or minimal damage still experienced considerably reduced productivity. Indirect costs exceeded direct, on average, by 4.5-fold, underscoring the importance of incorporating lost productivity in estimating the economic burden of SLE.