AWARENESS AND SENSITIVITY OF VALUE OVER COST IN THE PROSTATE CANCER CASTRATION SCENARIO: A PHARMACOECONOMIC PERSPECTIVE
Financial toxicity has been an exponentially growing concern causing patient distress, as devastating as other adverse medical events and impacting treatment non-adherence, quality of life, morbidity and mortality. Surgical castration can be >30x less expensive than pharmacological in 5 years with similar oncological and functional impact.
To explore the urology community awareness and sensitivity of value over cost under a pharmacoeconomic perspective in the metastatic prostate cancer castration scenario.
In a urology meeting, 100 consecutive urologists were interviewed to answer to 12 multiple-choice questions regarding their perceptions of value, cost and pharmacoeconomy of prostate cancer castration.
Among 100 urologists, 66 used to treat prostate cancer or perform surgical castration and answered to the questionnaire, and 34 did not or refrained to participate. Among the n=66 participants, n=25 (37.8%) had over 15 years and n=20 (30.3%) 5 to 15 years of practice while n=14 (21.2%) worked in academic environment. Overall, pharmacological castration is offered to 78.05% (mean, SD 28.06, median 90%) of patients (62.5% in academic versus 82.2% in non-academic environment, p=.018) and the percentage will significantly drop to 54.21% (mean, SD 38.88, median 50.00%), p<.0001 in case of increasing 10x the amount paid to the urologist to perform a surgical castration, a big effect (0.88) on Cohen test. Those that considered superior value over cost in surgical castration n=40 (60.6%), are significantly more susceptible to financial incentive, p=.036, while those that considered pharmacological castration due to drug qualities n=8 (12.1%) are significantly less susceptible, p=.044. The number of surgical castrations needed to save money enough to provide 1patient access to a new drug (abiraterone, enzalutamide, etc) was considered zero by n=23 (34.85%), 5-15 by n=29 (43.93%) and 15-25 by n=14 (21.21%) urologists.
There is a huge potential to fight financial toxicity without compromising the quality and efficiency of prostate cancer treatment. Urology community is sensitive to the fact that cost is not necessarily translated to value in the prostate cancer castration scenario.
pharmacoeconomics; cost; value; prostate cancer
Unicamp - Sao Paulo - Brasil
Leonardo O Reis, Danilo L Andrade, Marcelo P Amaro, Natássia C. C. Truzzi, Barbara R Malkomes