Comparison of the costs of treating prostate cancer with standard chemotherapy regimens versus targeted nuclear medicines.

Abstract

Background: Healthcare costs for the treatment of mCRPC continue to rise year on year. However, with the advent of targeted Nuclear medicine and continued treatment with standard chemotherapy regimen for the treatment of mCRPC the costs are still not known. Aim: We sought to compare the costs of treating mCRPC with standard chemotherapy regimen versus targeted Nuclear Medicine. Methods: We conducted a retrospective and prospective inferential study on patients, diagnosed with mCRPC, aged >18 years at Steve Biko Academic Hospital (SBAH), Pretoria and Inkosi Albert Luthuli Central Hospital (IALCH) in Durban, South Africa. The patients were referred to the treatment centres between the periods 1 January 2017 and 24 November 2019. We employed the International Classification of Diseases, 10th Revision Code system to identify mCRPC patients and match them with their Medical Record Number using MediTechTM computer Software program at IALCH, and a thorough patient file audit at SBAH was used to identify patients who were treated for mCRPC in this hospital during the study period. Treatment, Imaging, Screening, Out-patient and hospitalisation costs were extracted from the MediTechTM system using the Activity Based Costing Model and costs were compared to the costs derived from the patient files for the Nuclear Medicine patients. Results: A total of 60 patients (n=49, Chemotherapy Cohort, and n=11, Nuclear Medicine Cohort) with mCRPC, Mean ages at diagnosis 66 and 61 years respectively. The most common chemotherapy used were Bicalutamide, Goserelin and Docetaxel, compared to one comparator LuPSMA-Radioligand. The total healthcare costs for Chemotherapy were estimated at 500 000USD ($), whilst the costs for Lu-PSMA-Radioligand averaged 184 000USD ($). Imaging costs for chemotherapy were 37% higher than Lu-PSMA costs, in- hospital and out-patient costs accounted for 88% of the total healthcare costs. 2 Conclusions: For the treatment of metastatic resistant Prostate Cancer, patients treated with Chemotherapy regimen incur more cost for chemotherapy (43%) and imaging (37%) than patients treated with targeted nuclear medicine. Chemotherapy treated patients experience more in-patient and out-patient days compared to patients treated with targeted nuclear medicine. There are significantly more chemotherapy cycles and drug combinations that contribute to the higher chemotherapy costs.