Total Medical and Pharmacy Costs for Patients With Metastatic Castration- Sensitive Prostate Cancer Initiating Oral Androgen Receptor Pathway Inhibitors in the United States

This descriptive study aimed to evaluate the total cost of care and components of health care resource use and costs in androgen receptor path­way inhibitor (ARPI)-naïve Medicare-insured patients with metastatic castra­tion-sensitive prostate cancer (mCSPC) who initiated their first ARPI. Clinical data from US community urology practices (Precision Point Specialty Analytics) were linked with administrative claims (Komodo Research Database; January 1, 2016, to September 30, 2022) to selected Medicare-insured patients with mCSPC who newly initiated apalutamide, enzalutamide, or abiraterone acetate. Patients with ≥ 12 months of continuous insurance eligibility were followed from the date of first use of apalutamide, enzalutamide, or abiraterone acetate (index date) until the earliest of castration-resistance progression, treatment discontinua­tion, initiation of a new therapy, end of continuous insurance eligibility, or end of data availability. All-cause and prostate cancer (PC)–related health care costs per patient per year (PPPY; 2022 US dollars) were summarized using descrip­tive statistics. A total of 152 patients receiving apalutamide (mean on treatment duration of 7.3 months), 189 patients receiving enzalutamide (mean on treat­ment duration of 7.7 months), and 387 patients receiving abiraterone acetate (mean on treatment duration of 9.4 months) were included. Mean all-cause total costs PPPY were $128 187 (apalutamide), $145 382 (enzalutamide), and $114 959 (abiraterone acetate). Mean PC-related total costs PPPY were $116 416 (apalu­tamide), $132 236 (enzalutamide), and $100 338 (abiraterone acetate). Mean all-cause medical costs PPPY were $22 902 in the apalutamide cohort, $30 933 in the enzalutamide cohort, and $35 625 in the abiraterone acetate cohort. Similar trends were observed for mean PC-related medical costs PPPY: $15 067 (apalu­tamide), $20 968 (enzalutamide), and $24 760 (abiraterone acetate). Mean all-cause pharmacy costs PPPY were $105 285 (apalutamide), $114 450 (enzalu­tamide), and $79 334 (abiraterone acetate). Observed variations in medical costs between ARPIs may provide an early indicator of their ability to manage PC.