Utilization, Cost, and Subsequent Salvage Treatment of Ablative Therapies for Localized Prostate Cancer in the United States.

INTRODUCTION

Ablative therapy (AT) procedures are an emerging first-line treatment of newly diagnosed localized prostate cancer. We studied the trend in utilization and total healthcare and patient-incurred cost of first-line AT in the United States, as well as the receipt of salvage therapies after AT, using two insurance claims-based databases.

METHODS

We used the Merative MarketScan Commercial (CCAE) and Medicare (MDCR) Databases to identify men with non-metastatic prostate cancer treated with either cryotherapy, laser ablation, or high-intensity focused ultrasound between 2009 and 2022. Multivariable logistic regression was used to measure the association of covariates with receipt of each treatment. Year-to-year utilization between 2009 and 2021 was compared using Spearman's rank correlation test. Median inflation-adjusted total healthcare expenditures and patient out-of-pocket payments within 12 months of AT were calculated. Receipt of salvage therapies after AT was studied using cumulative incidence curves.

RESULTS

We identified 2200 men in CCAE and 3205 men in MDCR treated with AT between 2009 and 2022. In CCAE, 1.96 per 100,000 enrollees were treated with AT in 2009, and 1.51 per 100,000 enrollees were treated with AT in 2021 (P = .064). In MDCR, 31.36 per 100,000 enrollees were treated with AT in 2009, and 15.81 per 100,000 enrollees were treated in 2021 (P = .078). In CCAE, median total and patient costs were $24,506 and $1811, respectively. In MDCR, median total and patient costs were $22,094 and $1098, respectively. The 5-year rate of any salvage therapy was 24.5% in the CCAE and 22.3% in the MDCR. Androgen deprivation therapy (ADT) was the most frequently utilized salvage treatment in both the CCAE (33.0%) and MDCR (59.3%).

CONCLUSION

There was a similar utilization of AT across the study period. Over 20% patients received additional therapy, most frequently ADT, within 5 years of AT.