Real-World Clinical and Economic Outcomes Among Patients with Localized Prostate Cancer Undergoing Radical Prostatectomy Across Different Risk Stratifications in the United States.

Abstract

Background: Radical prostatectomy is a potentially curative treatment for localized prostate cancer (LPC), but there is limited literature comprehensively describing clinical and economic outcomes stratified by risk group. This study compared survival and healthcare costs following radical prostatectomy between patients with high-risk and low/intermediate-risk LPC in routine urology practice in the US.

Methods: Linked electronic medical records and administrative claims were used to identify men with LPC undergoing radical prostatectomy (index date). Patients were classified into high-risk or low/intermediate-risk cohorts based on staging, prostate-specific antigen test results, and Gleason score, in alignment with the National Comprehensive Cancer Network^®. Cohorts were balanced using inverse probability of treatment weighting. Metastasis-free survival and event-free survival post index were compared between cohorts using a weighted Cox proportional hazards model. All-cause/prostate cancer (PC)-related healthcare costs were compared post index using weighted ordinary least squares regression in a subgroup of patients with 12 months of continuous insurance eligibility prior to/including index.

Results: Patients in the high-risk cohort (N=7542) had significantly higher rates of metastasis (36 months: hazard ratio [95% confidence interval (CI)]: 3.80 [3.31, 4.38], p<0.001; 60 months: 3.59 [3.19, 4.04], p<0.001) and disease progression (36 months: 3.49 [3.28, 3.71], p<0.001; 60 months: 3.37 [3.18, 3.57], p<0.001) compared to patients in the low/intermediate-risk cohort (N=11,429). In the cost subgroup, the high-risk cohort (N=1488) incurred significantly higher mean total all-cause healthcare costs (cost difference [95% CI]: $9134 [5999, 12,400] per-patient-per-year, p<0.001) and mean total PC-related healthcare costs ($7502 [4718, 10,279] per-patient-per-year, p<0.001) compared to the low/intermediate-risk cohort (N=2572) post index.

Conclusion: In this real-world analysis of patients with LPC who underwent radical prostatectomy, high-risk disease was significantly associated with poorer survival and higher healthcare costs post-procedure compared to low/intermediate-risk LPC. These findings demonstrate the heightened clinical and economic burden observed with high-risk LPC.