The burden of symptomatic skeletal events in castrate-resistant prostate cancer patients with bone metastases at three Canadian uro-oncology centres

  • Fred Saad Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
  • Neil E. Fleshner Princess Margaret Cancer Centre, Toronto, ON, Canada
  • Alan So University of British Columbia, Vancouver, BC, Canada
  • Jacques Le Lorier Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
  • Louise Perrault International Market Access Consulting, Zug, Switzerland
  • Melanie Poulin-Costello Amgen Canada Inc., Mississauga, ON, Canada
  • Raina Rogoza Amgen Canada Inc., Mississauga, ON, Canada
  • Ewan J.D. Robson Amgen Canada Inc., Mississauga, ON, Canada.

Abstract

Introduction: Metastatic bone disease in castrate-resistant prostate cancer (CRPC) carries risks of significant morbidity, including symptomatic skeletal events. We estimated the healthcare resource costs of managing skeletal events.

Methods: A retrospective chart review was conducted for patients who died from or were treated palliatively for metastatic CRPC from 2006–2013 at Centre Hospitalier de l’Université de Montréal (Montreal), Princess Margaret Cancer Centre (Toronto), or Vancouver General Hospital (Vancouver).

Results: Of 393 patients, 275 (70%) experienced 833 events (85 per 100 patient-years), with a median time to first event of 17.6 months (95% confidence interval [CI] 15.3, 21.7). The mean metastatic bone disease-related healthcare resource use cost (2014 Canadian dollars) estimate for patients without symptomatic skeletal events was $9550 and between $22 101 (observed) and $34 615 (adjusted) for patients with at least one event. Fewer patients in Montreal (55%) experienced events compared to Toronto (79%) or Vancouver (76%). Median time to first event was longer in Montreal (25.0 months [18.5, 32.6]) than in Toronto (14.6 months [9.7, 16.8]) or Vancouver (17.3 months [14.8, 24.0]). More patients received bone-targeted therapy in Montreal (64%) and Toronto (60%) than in Vancouver (24%). Bone-targeted therapy was mostly administered every 3–4 weeks in Montreal and every 3–4 months in Toronto.

Conclusions: Metastatic bone disease-related healthcare resource use costs for Canadian CRPC patients are high. Symptomatic skeletal events occurred frequently, with the incremental cost of one or more events estimated between $12 641 and $25 120. Symptomatic skeletal event incidence and bone-targeted therapy use varied considerably between three Canadian uro-oncology centres. An important limitation is that only patients who died from prostate cancer were included, potentially overestimating costs.

Author Biographies

Fred Saad, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada

Dr. Fred Saad is the Principal Scientist and Full Professor in the Department of Surgery, Université de Montréal.  He is also the Medical Director, Interdisciplinary Urologic Oncology Group, CHUM, the Chair in Prostate Cancer Research, Université de Montréal and the Head of Urologic Oncology at CHUM.

Neil E. Fleshner, Princess Margaret Cancer Centre, Toronto, ON, Canada
Dr. Neil Fleshner is Chair and Professor at the Division of Urology, University of Toronto. Dr. Fleshner is certified in both urology and epidemiology. He earned his MPH degree from the School of Public Health at Columbia University and completed his oncology training at Memorial Sloan Kettering Cancer Center.
Alan So, University of British Columbia, Vancouver, BC, Canada
Dr. Alan So is a Senior Research Scientist at the Vancouver Prostate Centre and Associate Professor in the Department of Urologic Sciences, University of British Columbia; and Active Staff at the Vancouver General Hospital
Jacques Le Lorier, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
Dr. LeLorier is a Principal Scientist and Full Professor in the Departments of Medicine and Pharmacology, Université de Montréal and Chief of the Pharmacoepidemiology and Pharmacoeconomics Research Unit, CRCHUM
Louise Perrault, International Market Access Consulting, Zug, Switzerland
Ms. Perreault serves as President and Chief Executive Officer of International Market Access Consulting GmbH.
Published
2018-06-19
How to Cite
Saad, F., Fleshner, N. E., So, A., Le Lorier, J., Perrault, L., Poulin-Costello, M., Rogoza, R., & Robson, E. J. (2018). The burden of symptomatic skeletal events in castrate-resistant prostate cancer patients with bone metastases at three Canadian uro-oncology centres. Canadian Urological Association Journal, 12(12). https://doi.org/10.5489/cuaj.5053
Section
Original Research