Introduction:

Since the work of Huggins, blockade of androgen signaling has become a mainstay in the treatment of advanced prostate cancer. Although these therapies improve survival, they are associated with significant costs. Understanding the associated costs with androgen deprivation therapy (ADT) and antiandrogens is an important component to the management of biochemical recurrence (BCR), metastatic hormone sensitive prostate cancer (mHSPC) and castration resistant prostate cancer (CRPC) patients. The aim of this study is to describe the relative cost of antiandrogen and ADT and to identify recent prescribing trends.

Methods:

Using Medicare Physician & Other Practitioners and Part D Drug Databases, we extract all drug claims and services made by urologists from 2013 to 2019. Total drug costs in each year and nominal costs for Antiandrogens: Abiraterone Acetate, Apalutamide and Enzalutamide and ADTs: Leuprolide Acetate, Triptorelin Pamoate, Goserelin Acetate and Degarelix Acetate are found and percentages are then derived. Estimated cost per treatment day is derived from dividing ‘total drug cost’ by ‘covered treatment days’ (note: one 30-day claim is equivalent to 30 treatment days).

Results:

Drugs prescribed by urologists to MPD beneficiaries exceeded $1.6 billion in 2019. 31.4% was due to antiandrogens which accounted for 0.4% of urologic drug claims. Meanwhile, ADT steadily accounted for 1.4 to 1.8% of costs under Part D and 8.4 to 9.3% of costs under Part B. The number or urologists prescribing antiandrogens increased 13-fold during the study period: 118 urologists in 2013 to 1691 urologists in 2019. The estimated cost-per-day for ADT was $50 or less per-day under Part D and $10 or less under Part B. The estimated cost-per-day for for antiandrogen therapy approached $400 per-day in 2019 (ie $12,000/month or $144,000/year).

Conclusion:

Of drugs prescribed by urologists to MPD beneficiaries, one third of costs are from antiandrogens despite accounting for less than 0.5% of all claims. More urologists are prescribing antiandrogens every year. The estimated cost per day for patients on antiandrogen therapy is substantially higher than ADT. Financial costs should be discussed during the shared decision making process in patients with BCR, mHSPC or CRPC.

Funding: N/A