Introduction:

Real world studies have shown better clinical outcomes and lower medical costs in patients with metastatic castration sensitive prostate cancer (mCSPC) treated with apalutamide than enzalutamide and abiraterone acetate. Darolutamide is a newer approved androgen receptor pathway inhibitor (ARPI) for mCSPC. However, there are limited data characterizing healthcare resource utilization (HRU) and costs among patients treated with darolutamide in the real-world setting. This study described HRU and costs among patients with mCSPC treated with apalutamide or darolutamide.

Methods:

A retrospective descriptive analysis was conducted using healthcare claims from the Komodo Research Dataset. Patients with mCSPC who initiated apalutamide (APA) or darolutamide (DARO) (index date = date of first apalutamide or darolutamide paid pharmacy claim) on or after August 5, 2022 and had ≥12 months of pre-index continuous plan enrollment (baseline period) were included. Patients initiating darolutamide were stratified by receipt (DARO+C) or not (DARO-NC) of concurrent chemotherapy. Patients were followed from index until the earliest of discontinuation of index ARPI, add-on or switching to chemotherapy (except for DARO+C cohort), switching to another ARPI, add-on or switching to another advanced prostate cancer treatment, progression to castration resistance, death, end of continuous plan enrollment, or end of data availability (October 4, 2024). All-cause and prostate cancer (PC)-related HRU and medical costs per-patient-per-year (PPPY) were reported during the baseline and follow-up periods.

Results:

Among patients with mCSPC, 1045 initiated apalutamide and 1317 initiated darolutamide (619 [47.0%] DARO+C; 698 [53.0%] DARO-NC). Mean age (years) was 71.9 (APA), 63.8 (DARO+C), 68.5 (DARO-NC). Mean follow-up (months) was 5.4 (APA), 6.7 (DARO+C), 5.0 (DARO-NC). Most patients had de novo mCSPC on index (66.4% APA; 90.0% DARO+C; 75.1% DARO-NC) and used androgen deprivation therapy (87.7% APA; 96.9% DARO+C; 84.7% DARO-NC) within 6 months before or after index. Descriptive variations in certain baseline characteristics across cohorts were observed, including Medicare insurance (61.6% APA; 29.2% DARO+C; 48.6% DARO-NC) and metastases: bone (71.1% APA; 87.6% DARO+C; 79.1% DARO-NC) and visceral (9.4% APA; 16.5% DARO+C; 13.5% DARO-NC). During follow-up, PC-related inpatient admissions occurred in 6.6% (APA), 14.1% (DARO+C), 9.5% (DARO-NC) of patients; mean length of stay for PC-related acute inpatient admissions was 10.2 (APA), 15.5 (DARO+C), 17.9 (DARO-NC) days PPPY. Mean PC-related medical cost PPPY was $26,625 (APA), $59,595 (DARO+C), $31,654 (DARO-NC).

Conclusion:

In this descriptive study of patients with mCSPC initiating apalutamide or darolutamide, variations in post-index annual medical HRU and costs were observed across cohorts, with the highest values observed for those initiating DARO+C, followed by DARO-NC then APA. While these observed differences in medical costs could reflect clinical outcomes for prostate cancer, further adjusted analyses in balanced cohorts are warranted to better assess HRU and costs in patients with mCSPC initiating ARPIs.

Funding: Johnson & Johnson