OBJECTIVES: Advanced prostate cancer (PC) standard of care utilizes androgen deprivation therapy (ADT) with gonadotropin-releasing hormone (GnRH) receptor agonists to induce castration and PC cell death. In 2010, the Federal Drug Administration required the addition of new safety information to the labels of GnRH agonists warning of increased risk of cardiovascular (CV) events in men receiving these medications. This study assessed CV-related events in this patient population, with a focus on related hospitalizations and costs.

METHODS: Men receiving ADT with ≥2 claims for a diagnosis of PC were identified in the Marketscan Commercial and Medicare Supplemental Database (1/1/2009-12/31/2018). Index date was the first ADT claim. Patients were required to be continuously enrolled 6-months pre- and ≥2 months post-index. Patients with a major adverse cardiovascular event (MACE: myocardial infarction, cerebrovascular accident, unstable angina, percutaneous coronary intervention, and/or coronary bypass graft) post index and insurance eligibility for ≥30 days after MACE were identified. Thirty-day (30) post-MACE hospitalizations and MACE-related costs (2018 USD) were assessed.

RESULTS: The study included 49,155 men with PC on ADT; 8,102 patients (16.5%) experienced a MACE during the whole study period. A total of 6,754 (13.7%) qualified for the post-MACE analysis; most had Medicare (86.6%) coverage. In the 30-days post-event, a high proportion of patients incurred a MACE-related hospitalizations (Medicare: 46.6%; Commercial: 45.1%); inpatient costs among patients with ≥1 admission were $36,185 (SD: $62,654) and $55,322 (SD: $69,539) in Medicare and commercial patients, respectively.

CONCLUSIONS: PC patients treated with GnRH agonists are at increased risk of CV events. When MACE occurs, patients likely require a hospitalization associated with substantial inpatient costs. ADTs that lower CV risk have the potential to improve patient outcomes while reducing healthcare costs.