Weight management medication utilization and outpatient costs in patients with prostate cancer and diabetes.

13 Background: Prostate cancer (PC) and type 2 diabetes (T2D) commonly coexist and PC treatments such as androgen deprivation therapy (ADT) can increase the risk for developing T2D. GLP-1 receptor agonists (GLP-1 RA) have demonstrated metabolic and potential oncologic benefits along with lower healthcare costs after initiation. We evaluated GLP-1 RA utilization and non-medication healthcare costs among patients with PC and T2D. Methods: We conducted a retrospective cohort study using the MarketScan Database. Eligible patients were 18-95 years old, with T2D and overweight/obese per ICD-9/10 coding, diagnosed with PC (2008 – 2021), and treated with definitive surgery or radiation. The study was limited to patients who received either a GLP-1 RA or other glucose lowering medication within 1 year after treatment. Exclusions included bariatric surgery within one year prior to treatment, metastatic disease, or secondary prostate cancer. Mean outpatient healthcare costs (office visits, outpatient facility, emergency department) over 12 months after treatment were compared for those prescribed a GLP-1 RA after treatment versus those prescribed other glucose-lowering medications after treatmentWe fit a multivariable Logistic regression model to determine factors associated with receipt of GLP-1 RA. We conducted a generalized linear model with a log link and gamma-distributed residuals to adjust cost for treatment type, weight category, age, region, comorbidities, insurance, and ADT receipt. Unadjusted costs were compared using the Wilcoxon rank-sum test. Results: We identified 3,241 eligible patients, of which 204 (6.3%) received treatment with a GLP-1 RA. In the GLP-1 RA group, 8.8% were overweight, 53.4% were obese class I/II/unspecified, and 37.7% were obese class III, compared to 13.2%, 58.4%, and 28.4% in the control group. ADT use was higher in the GLP-1 RA group (27.9% vs. 21.8%, p 0.0421). From 2009 to 2021, GLP-1 RA use increased from 0.7% to 15.6% (p < 0.001). In a multivariable analysis, GLP-1 RA receipt within 1 year of PC treatment was associated with obesity class III (aOR 2.04 95%CI 1.18-3.52), younger age (aOR 3.09 95%CI 1.35-7.09), and receipt of ADT (aOR 1.51 95%CI 1.02-2.23). Against expectations, after excluding drug costs, we found the GLP-1 RA group had a slightly higher mean total outpatient care costs over 1 year with $30,912 compared to the control group with $25,811 (p 0.01). Emergency department and inpatient admissions did not differ during any time period. When adjusted, the GLP-1 RA group mean total cost was $37,559 compared to $32,481 (p 0.051). Conclusions: Among patients with PC and T2D, GLP-1 RA use has increased, and has not shown short-term cost saving benefits although long-term research is needed to assess downstream benefits. Future studies should elucidate the benefits, risks, and healthcare costs of GLP-1 RA utilization in patients with advanced cancer.