Total expenditure on prostate cancer-related health care has increased sharply in the US over a 10-year period, according to research published in JAMA Network Open.

Systemic therapy, principally second-generation androgen deprivation therapy (ADT), appears to be the main driver of the increase, study researchers reported.

For this economic analysis, the researchers drew on Surveillance, Epidemiology, and End Results-Medicare linked data from January 1, 2012, to December 31, 2021. They integrated provider and claims data to examine inpatient stays, outpatient services, physician and supplier services, and prescription drug costs.

The researchers focused on patients with prostate adenocarcinoma, specifically on claims with a primary diagnosis of prostate cancer, and services paid under traditional fee for service terms, with all costs adjusted to 2017 dollars.

Costs were categorized as relating to radiation, surgery, cryotherapy and high-intensity focused ultrasonography, systemic therapy, and diagnostic and monitoring services. Systemic therapies were further divided into first- and second-generation ADTs, and other therapies.

A total of 1 ,231 ,567 Medicare beneficiaries with prostate cancer were included in the analysis, including 756,951 diagnosed in 2012-2014, 205,433 diagnosed in 2015-2017, and 269,183 diagnosed in 2018-2021.

The mean age of the patients at diagnosis was 73.2 years, and the median follow-up was 88 months. The majority of patients (86.4%) were White, and 10.1% were Black. The proportion of patients with metastatic disease at diagnosis, among those for whom complete clinical information was available, rose from 4.0% in 2012-2014 to 5.2% in 2018-2021.

The researchers found that total expenditures for prostate cancer-related health care increased from $504 million in 2012 to $796 million in 2016 to $1.9 billion in 2021. However, they noted that the “proportional contribution of traditional curative interventions declined over time.”

Expenditure on radiotherapy remained comparatively constant over the study period, at $227 million in 2012, $180 million in 2016, and $228 million in 2021, but its relative contribution to overall costs declined from 45.0% to 22.6% to 12.0%, respectively.

Spending on surgery was also relatively stable, at $53 million in 2012, $52 million in 2016, and $67 million in 2021, but its share of overall costs fell from 10.5% to 6.5% to 3.5%, respectively.

The largest driver of the cost increases was systemic therapy, with spending rising from $142 million, or 28.1% of overall costs, in 2012, to $468 million (58.8%) in 2016 and $1.4 billion (74.0%) in 2021.

Looking at systemic therapy in detail, the researchers found that spending on first-generation ADTs rose from $57 million in 2012 to $72 million in 2016 and $105 million in 2021, compared with $46 million in 2012, $335 million in 2016, and $1.2 billion in 2021 for second-generation ADTs.

By 2021, second-generation ADTs accounted for 86.6% of total spending on systemic therapy, and 64.0% of the total aggregate prostate cancer-related health care spending.

The amount spent on diagnostic monitoring services was $100 million, or 19.8% of the total, in 2012, $108 million (13.6%) in 2016, and $219 million (11.4%) in 2021, while spending on cryotherapy and high-intensity focused ultrasonography throughout the study period was “minimal,” according to the researchers.

“As treatment paradigms continue to evolve, understanding care delivery across the disease course will be important for informing future clinical, research, and policy discussions related to the sustainability of prostate cancer care,” the researchers concluded.

Disclosures: There was no funding listed for this study. Some study authors disclosed conflicts of interest. Please see the original reference for complete disclosures.