Provider mix and costs associated with treatment of patients with bone metastases secondary to prostate cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15175-e15175
Author(s):  
Kenneth M. Shermock ◽  
Sean D Sullivan ◽  
Scott David Ramsey ◽  
Brian S. Seal
Keyword(s):  
Prostate Cancer ◽  
Bone Metastases ◽  
Claims Data ◽  
Treatment Patterns ◽  
Pharmaceutical Treatment ◽  
Medical Claims ◽  
Icd9 Code ◽  
Diagnostic Role ◽  
Procedure Codes

e15175 Background: Treatment of patients with bone metastases secondary to prostate cancer can involve several provider types and combinations of chemotherapy, surgery, radiation, and pharmaceutical treatment. This study evaluated the combinations of provider types and associated treatment patterns for a cohort of patients with bone metastases secondary to prostate cancer. Methods: Continuously enrolled patients older than 20 years of age in the MarketScan database between January 2004 and December 2010 with evidence of bone metastases (ICD9 code 198.5 or treatment with zolderonic acid, pamidronate, or demosumab) were included. Inpatient and outpatient medical claims data were used to define provider combinations. Treatment patterns were determined from prescription fill/refill claims and procedure codes from inpatient and outpatient medical claims. Results: A total of 4,493 patients had evidence of bone metastases. A radiologist was involved in care for a vast majority (n=4,054, 90%). Less than half of the population, (n=1,751, 39%) had an oncologist actively involved in care. Most patients (n=2633, 59%) had both an urologist and a radiologist involved in their care. The most common combinations of providers were urologist and radiologist (n=998, 22%); urologist, radiologist, and surgeon (n=951, 21%), and urologist, radiologist, and oncologist (n=781, 17%). About 15% (n=684) of patients had a surgeon, urologist, oncologist, and radiologist involved in their care. Only approximately half (n=2,274, 51%) of the population had evidence of receiving radiation therapy, suggesting that the radiologist plays a diagnostic role for many patients. A vast majority of patient were prescribed hormone therapy (89%) and 76% were prescribed steroid agents (mostly glucocorticoids). Less than half of the population (n=1,838, 41%) received surgery related to their prostate cancer. Conclusions: There is significant variation in combinations of provider types and associated treatment patterns for patients who have bone metastases secondary to prostate cancer. Follow-up studies should examine optimal conditions for different provider mixes and treatment patterns.

Evaluation of treatment patterns and costs for patients with prostate cancer and bone metastases.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 215-215
Author(s):  
Adriana Valdarrama ◽  
Jianying Yao ◽  
Lonnie Kent Wen
Keyword(s):  
Prostate Cancer ◽  
Bone Metastases ◽  
Treatment Initiation ◽  
Treatment Patterns ◽  
Median Cost ◽  
Inclusion Criteria ◽  
Radium 223 ◽  
Castrate Resistant Prostate Cancer ◽  
Castrate Resistant

215 Background: To describe treatment patterns and costs of care associated with the use of FDA-approved agents for metastatic castrate-resistant prostate cancer (mCRPC). Methods: Two large integrated claims databases (MarketScan, PharMetrics) were used to identify males ≥ 18 years old diagnosed and treated for prostate cancer (ICD9 = 185.xx or 233.4) with bone metastases (ICD9 = 198.5) from 06/2013 to 09/2014. Patients were required to be continuously enrolled ≥ 6 months pre- and post-initiation of treatment with abiraterone, cabazitaxel, docetaxel, enzalutamide, mitoxantrone, radium-223, or sipuleucel-T. Results: There were 953 and 565 patients meeting all inclusion criteria in each database, with a median follow-up time of 18 and 14 months, respectively. Mean age was 69 to 71 years. Prior to mCRPC treatment initiation, 14.0% to 18.2% of patients received radiation therapy, 36.1% to 40.0% denosumab, 16.5% to 16.8% zoledronic acid, and 0.2% to 0.8% pamidronate. Across both databases, abiraterone was most commonly received agent across all lines of therapy, except fourth line (Table 1). The median cost per patient per month during the post-index period was $10,292 to $10,916 in the each database, respectively, compared to $2,643 to $2,742 per patient per month during the 6-month pre-index period. Conclusions: Patients were treated mainly with abiraterone across most lines of care, with bone-targeted therapy being used in < 3% of patients. Median costs per patient per month increased approximately ~$8,000 over this period. [Table: see text]

Initial treatment patterns and outcome of contemporary prostate cancer patients with bone metastases at initial presentation

Cancer ◽  
2007 ◽  
Vol 110 (1) ◽  
pp. 81-86 ◽  
Author(s):  
Charles J. Ryan ◽  
Eric P. Elkin ◽  
Janet Cowan ◽  
Peter R. Carroll
Keyword(s):  
Prostate Cancer ◽  
Bone Metastases ◽  
Cancer Patients ◽  
Initial Treatment ◽  
Treatment Patterns ◽  
Initial Presentation

scholarly journals Re‐treatment with radium‐223: 2‐year follow‐up from an international, open‐label, phase 1/2 study in patients with castration‐resistant prostate cancer and bone metastases

The Prostate ◽  
2019 ◽  
Vol 79 (14) ◽  
pp. 1683-1691 ◽  
Author(s):  
Oliver Sartor ◽  
Daniel Heinrich ◽  
Neil Mariados ◽  
Maria José Méndez Vidal ◽  
Daniel Keizman ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Bone Metastases ◽  
Phase 1 ◽  
Castration Resistant Prostate Cancer ◽  
Open Label ◽  
Castration Resistant ◽  
Radium 223 ◽  
Open Label Phase

Contemporary treatment patterns and short-term outcomes in men with very high-risk prostate cancer.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 103-103
Author(s):  
Jeffrey J. Tosoian ◽  
Debasish Sundi ◽  
Brian Francis Chapin ◽  
Emmanuel S. Antonarakis ◽  
Meera Chappidi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Trials ◽  
Lymph Node ◽  
High Risk ◽  
Local Treatment ◽  
Treatment Patterns ◽  
Short Term ◽  
Gleason Pattern ◽  
Very High

103 Background: Beginning in 2014, the National Comprehensive Cancer Network (NCCN) recognized very high-risk (VHR) prostate cancer (cT3b-T4, or primary Gleason pattern 5, or more than 4 biopsy cores with Gleason score 8-10, or multiple HR features) as a classification distinct from high-risk (HR) disease. Using prospectively collected institutional data, we describe contemporary treatment patterns and short-term outcomes in the VHR population. Methods: Men who underwent radical prostatectomy (RP) between January 2010 and June 2015 were identified using the Johns Hopkins RP database, and trends in management were compared across the study period. Pathological and short-term clinical outcomes were assessed in men with VHR cancer. Non organ-confined disease (NOCD) was defined as ≥ pT3 disease or lymph node positivity, persistent postoperative PSA as ≥ 0.2 ng/mL, and biochemical recurrence (BCR) as a PSA ≥ 0.2 ng/mL following an initial undetectable postoperative PSA. Results: During the study period, 4,954 men underwent RP, of which 161 (3.2%) men had VHR cancer at diagnosis. The annual proportion of men who underwent RP with VHR cancer increased over the study period (chronologically 1.8%, 1.0%, 3.3%, 4.1%, 5.6%, and 5.2%; p<0.001). Sixteen percent of men with VHR disease were enrolled in pre-surgical clinical trials, with an increase from 0% of men in 2010 to 19.1% in 2015 (p=0.11). At RP, 39% of the VHR cohort had seminal vesicle invasion, 26% had lymph node involvement, and a total of 74% had NOCD. Following surgery, 33% of men had PSA persistence, and 40% experienced either PSA persistence or BCR during follow-up (median 13.4 months). Of 136 men with at least one follow-up assessment, 15 (11.0%) developed metastasis; 33% of the cohort was treated with radiation therapy, 42% with androgen deprivation, and 15% with docetaxel. Conclusions: The VHR population carries the greatest risk of clinical progression following local treatment. Over the past five years, we have observed increasing surgical treatment and clinical trial enrollment at our institution. Continued assessment of post-operative interventions and outcomes will help to facilitate counseling and establish point estimates from which to power clinical trials.

Minimizing prostate cancer admissions via enhanced outpatient care: A model for savings.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 46-46
Author(s):  
Anish Parikh ◽  
Mark Sanderson ◽  
Luis M. Isola ◽  
Ronald D. Ennis
Keyword(s):  
Prostate Cancer ◽  
Outpatient Care ◽  
Claims Data ◽  
Clinic Visit ◽  
Financial Impact ◽  
Total Cost ◽  
Avoidable Admissions ◽  
The Cost ◽  
Medicare Claims Data

46 Background: Hospitalization is a major contributor to cost in oncology. Minimizing avoidable admissions can lead to substantial savings. Methods: We studied Medicare claims data from 160 admissions for prostate cancer (PCa) patients from 1/2012 to 5/2015. Admissions with the lowest 50th percentile of charges were assessed for being potentially avoidable by 2 independent chart reviews; remaining admissions were assumed to be unavoidable due to medical complexity. Common admitting diagnoses were targeted by theoretical care pathways designed to minimize avoidable admissions via expedited outpatient follow-up. We compared the cost of the avoidable admissions to that of implementing 3 such pathways then estimated the financial impact. Results: Total cost for all 160 admissions was $1,979,200. 25% of these admissions, accounting for $494,800, were deemed potentially avoidable. Our model exchanged each of these admissions for a routine clinic visit which led to an estimated $464,800 in savings, or a 23% improvement in total cost. The most common admitting diagnoses were fever (18%), pain (12%), and dehydration (8%). On review, 3/9 fever admissions in this set were deemed avoidable with 1 extra clinic visit, 3 with 3 visits, and 3 were unavoidable, yielding a 53% reduction in cost for this diagnosis. Similar analyses led to cost reductions of 75% and 66% for pain and dehydration admissions, respectively. Combining just these 3 theoretical interventions led to an estimated savings of $146,955, or a 7.4% improvement in total cost. Conclusions: A sizable portion of PCa admissions can be avoided, with ample savings, if a system is in place to provide the additional care that often exceeds the capabilities of a busy practice. [Table: see text]

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