Deborah Kaye, MD, on the Cost of First-Line Tx for Metastatic Castrate-resistant Prostate Cancer

Most studies of drug costs for metastatic castration-resistant prostate cancer (mCRPC) have looked at patients covered by Medicare. A recent study, however, examined costs for patients with private insurance through their employer.

"Because most of the research specific to this clinical context has been conducted among older patients enrolled in Medicare Part D, even less is known about payments for these drugs for patients with employer-sponsored health insurance," explained Deborah Kaye, MD, of Duke University Hospital in Durham, North Carolina, and colleagues.

As explained in their study in JCO Oncology Practice, the team examined and compared gross payments (made by insurance companies) and out-of-pocket patient costs for the six approved first-line mCRPC treatments, analyzing insurance claims data for 4,298 patients treated during 2013-2019.

In the following interview, Kaye discussed the results and the implications.

What drugs had the highest and lowest gross payments for insurance companies?

Kaye: Among the six treatments included in our study -- docetaxel, cabazitaxel, abiraterone, enzalutamide, sipuleucel-T, and radium-223 -- sipuleucel-T had the highest payments by the insurance company on a beneficiary's behalf and docetaxel had the lowest payments.

And the highest and lowest out-of-pocket costs for patients?

Kaye: On average, for patients, cabazitaxel had the highest out-of-pocket payments, followed by abiraterone. Patients incurred the lowest out-of-pocket payments for docetaxel. It is important to keep in mind that this study included data before abiraterone had a generic option available, which likely alters the out-of-pocket payment experienced by patients. In addition, there was a very wide distribution of what individuals paid for drugs, even for the same drug type.

What are the implications of this study for patients?

Kaye: These drugs potentially have large differences in out-of-pocket payments. A better understanding of these payments may help patients to better prepare for the potential large financial burden that is often associated with cancer care, have more robust discussions with clinicians about their goals and values, and make more informed decisions about treatments.

What are the implications for physicians?

Kaye: Similar to the implications for patients, it is important for clinicians to understand that out-of-pocket payments for patients may be highly variable across different drug types. It is critical to discuss costs of treatments with patients and assess patient values during shared decision-making.

If patient payments are unaffordable or high enough to cause distress, patients may not take medications as prescribed, may miss important clinic and/or monitoring visits, and may experience other symptoms of financial toxicity, with resultant worse health outcomes.

Is there anything else you would like to make sure oncologists understand about this study?

Kaye: This study includes patients with employer-sponsored health insurance. Prior work suggests these patients on average have lower out-of-pocket payments than patients with Medicare or no health insurance for some specialty medications. While some patients had fairly low out-of-pocket payments, there were certain patients who had very high out-of-pocket payments. It is therefore critical to understand an individual's payment estimate.

Furthermore, this study uses billing claims data from patients who received the treatments. There are potentially many individuals where the very high out-of-pocket payments made the treatment regimen prohibitive and they thus did not receive the therapy. These patients would not be captured in our analysis.

Read the study here.