Time to castrate the cost? the rising expense of chemical castration for the management of prostate cancer

Abstract

Background

Androgen deprivation therapy (ADT) remains the backbone of treatment of advanced prostate cancer. Conventionally, this is achieved by means of Gonadotropin Releasing Hormone (GnRH) analogs, though in recent years, four novel androgen receptor pathway inhibitors (nARPIs) have been approved for the treatment of advanced prostate cancer. We aim to analyze the increase in cost of chemical castration in advanced prostate cancer associated with the introduction of these medications.

Methods and methods

The publicly available Pharmaceutical Benefits Scheme database was accessed for conventional ADT and nARPI prescription data between January 2010 and January 2024. The number of prescriptions and cost of prescriptions were categorized by month and state. A descriptive analysis was performed outlining the therapy-prescribing patterns and discordances at a national and state-/territory-based level.

Results

From January 2010 to January 2024, over 1.7 million scripts were dispensed for conventional ADT compared to 412,925 for nAPRI therapy. The average cost for ADT rose from $9.9 million to 10.9 million. The average cost for nARPI therapy rose from $5.2 million to $17.3 million. There was significant difference between state-prescribing practices despite population-adjusted analysis.

Conclusions

While intensified treatment has proven to improve prostate cancer survival, this had led to an exponential increase in the cost of treatment. Clinicians must exercise caution when prescribing these medications to ensure patients will appropriately benefit from their advantage to cancer-specific survival in the context of their overall health to ensure appropriate distribution of resources.