Japanese journal of clinical oncology · 2026
Real-world trends in anti-androgen prescribing and associated costs for prostate cancer in Japan: a nationwide analysis.
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Omizo Sosuke, Narita Takuma, Hamaya Tomoko, Togashi Kyo, Ogawa Izuki, Tazawa Shunsuke, Ishimoto Keita, Sakao Miki, Mikami Jotaro, Fujita Naoki, Okamoto Teppei, Imai Atsushi, Yamamoto Hayato, Ohyama Chikara, Hatakeyama Shingo
Аннотация
OBJECTIVE: Anti-androgen therapy is central to prostate cancer management, but nationwide real-world trends in prescribing and costs remain insufficiently characterized in aging societies. We evaluated temporal trends in anti-androgen prescriptions and associated medical costs for prostate cancer in Japan using the National Database (NDB) Open Data.
METHODS: This retrospective study analysed outpatient prescription data from the NDB Open Data from 2016 to 2023. Prescription trends were assessed for bicalutamide (BIC), estramustine phosphate (EMP), flutamide (FLU), enzalutamide (ENZ), abiraterone, apalutamide, and darolutamide. Costs were estimated using an exchange rate of 150 JPY per USD. Trends were further stratified by age group and region.
RESULTS: Among 653.42 billion oral doses recorded during the study period, dose-adjusted prescriptions included 374.6 million for BIC, 25.2 million for EMP/FLU, and 57.6 million for androgen receptor signaling inhibitors (ARSIs). The share of ARSI prescriptions increased from 6.1% in 2016 to 19.4% in 2023, with ENZ being the most prescribed ARSI (9.5%). Although overall anti-androgen use increased among men aged ≥80 years, ARSI use in this group remained relatively stable at 12%-18%. Total anti-androgen-related medical costs increased 2.12-fold, and ARSIs accounted for 94.5% of these costs in 2023. Limitations include the lack of clinical details and the inability to distinguish disease states.
CONCLUSIONS: In Japan, ARSI use and related expenditures increased substantially between 2016 and 2023. Despite modest prescription volumes, ARSIs accounted for most anti-androgen-related costs.
METHODS: This retrospective study analysed outpatient prescription data from the NDB Open Data from 2016 to 2023. Prescription trends were assessed for bicalutamide (BIC), estramustine phosphate (EMP), flutamide (FLU), enzalutamide (ENZ), abiraterone, apalutamide, and darolutamide. Costs were estimated using an exchange rate of 150 JPY per USD. Trends were further stratified by age group and region.
RESULTS: Among 653.42 billion oral doses recorded during the study period, dose-adjusted prescriptions included 374.6 million for BIC, 25.2 million for EMP/FLU, and 57.6 million for androgen receptor signaling inhibitors (ARSIs). The share of ARSI prescriptions increased from 6.1% in 2016 to 19.4% in 2023, with ENZ being the most prescribed ARSI (9.5%). Although overall anti-androgen use increased among men aged ≥80 years, ARSI use in this group remained relatively stable at 12%-18%. Total anti-androgen-related medical costs increased 2.12-fold, and ARSIs accounted for 94.5% of these costs in 2023. Limitations include the lack of clinical details and the inability to distinguish disease states.
CONCLUSIONS: In Japan, ARSI use and related expenditures increased substantially between 2016 and 2023. Despite modest prescription volumes, ARSIs accounted for most anti-androgen-related costs.