JU INSIGHT: Out-of-pocket Cost Burden Associated With Contemporary Management of Advanced Prostate Cancer Among Commercially Insured Patients

By: Daniel D. Joyce, MD; Vidit Sharma, MD, MS; David H. Jiang, BS; Holly K. Van Houten, BA; Lindsey R. Sangaralingham, MPH; Bijan J. Borah, PhD; Eugene D. Kwon, MD; David F. Penson, MD, MPH, MMHC; Stacie B. Dusetzina, PhD; Jon C. Tilburt, MD, MPH; Stephen A. Boorjian, MD | Posted on: 01 Nov 2022

Joyce DD, Sharma V, Jiang DH, et al. Out-of-pocket cost burden associated with contemporary management of advanced prostate cancer among commercially insured patients. J Urol. 2022;208(5):987-996.

Study Need and Importance

The treatment landscape for advanced prostate cancer has evolved considerably over the past 20 years. During this time, costs of novel cancer therapies have continued to rise. Furthermore, responsibility for these costs is increasingly shifted to patients in the form of higher premiums, deductibles, and cost-sharing. These out-of-pocket costs (OOPC) represent an important component of financial toxicity and may impact patients’ receipt of care.

What We Found

In commercially insured men with advanced prostate cancer, we found that treatment-related OOPC from novel hormonal therapies averaged $4,236 annually and were over 18 times higher ($2,581 more) than androgen deprivation monotherapy after adjusting for relevant baseline patient characteristics. Similarly, annual total health care spending for novel hormonal therapies was $254,677, compared to $52,825 for nonandrogen systemic agents (see Table). Patient characteristics associated with high OOPC included older age, Black race, lower comorbidity scores, and lower median household income.


Patient-reported financial toxicity was not assessed, thereby limiting knowledge of the impact that our observed findings had on patients’ lives. Additionally, potentially relevant patient demographic and clinicopathological characteristics that could influence access to care and financial toxicity, such as employment status, marital status, pretreatment assets and savings, and disease stage/severity, were unable to be assessed. We did not have the statistical power to compare the individual drug regimens within each treatment group.

“Understanding the burden of OOPC is particularly important in disease states where multiple treatment options exist with similar oncologic benefits but varying costs.”

Interpretation for Patient Care

Understanding the burden of OOPC is particularly important in disease states where multiple treatment options exist with similar oncologic benefits but varying costs. Knowledge of the magnitude of OOPC differences between treatments may facilitate obtaining care in subsidized or lower cost settings when available and provide emphasis to studies evaluating non-inferiority of reduced dose scheduling. Additionally, our findings highlight important disparities in prostate cancer treatment and may help identify patients in most need of interventions to ameliorate financial toxicity.

Table. Comparative Out-of-pocket Costs and Total Health Care Spending Between Advanced Prostate Cancer Treatment Groups

Claims ADT, Mean (SD), $
(n = 10,926)
NHT, Mean (SD), $
(n = 832)
NAS, Mean (SD), $
(n = 1,651)
Medical 2,131 (2,453) 16,761 (36,042) 3,610 (2,982) 81,118 (96,384) 1,231 (3,923) 153,836 (153,154)
Pharmacy 693 (895) 4,811 (26,036) 4,254 (17,753) 251,226 (154,204) 955 (1,982) 33,910 (71,186)
Total 2,824 (2,699) 21,571 (46,697) 7,864 (17,955) 332,344 (174,890) 1,186 (4,376) 187,746 (176,893)
Total prostate cancer treatmenta 165 (584) 778 (2,865) 4,236 (17,704) 254,677 (163,002) 994 (2,344) 52,825 (98,316)
Abbreviations: ADT, androgen deprivation monotherapy; NAS, nonandrogen systemic agents; NHT, novel hormonal therapy; OOPC, out-of-pocket costs; THS, total health care spending.
aIncludes outpatient pharmacy claims and outpatient-administered medication costs for prostate cancer-related treatments.