The Impact of Socioeconomic Status (SES), Insurance Type, and Treatment Facility on Survival in Metastatic Prostate Cancer (MPC): A Systematic Literature Review (SLR) of Social Determinants of Health (SDOH)


Freedland S1, Hall A2, Lansing A2, Rai M2, Rosta E2, Niyazov A3, Nazari J3, Samjoo I2, Arondekar B4
1Cedars-Sinai Medical Center, Los Angeles, CA, USA, 2EVERSANA, Burlington, ON, Canada, 3Pfizer Inc., New York, NY, USA, 4Pfizer Inc., Collegeville, PA, USA

Presentation Documents


Prostate cancer is the second most common cancer among men worldwide. The prognosis for patients with mPC is poor, with survival greatly reduced compared to local/regional disease. Despite recent advancements, significant disparities in incidence, treatment, and survival by SDOH persist. We previously reported the association between race, a key SDOH, and overall survival (OS) in mPC. Herein, we examined additional SDOH.


An SLR was conducted to identify real-world evidence that examined the association of SDOH, including SES, private insurance, and treatment facility (academic/non-academic/community), on survival in mPC (PROSPERO registration: CRD42022350888). MEDLINE®, Embase, and Cochrane Library were searched from January 2012 to July 2022 using Ovid®. A supplemental search of key congresses was also conducted. Review implementation and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Cochrane guidelines.


After screening 3,228 records, 86 studies were identified that examined the association of SDOH on survival in mPC, 10 of which reported on SES (n=2; both ex-US focused), private insurance (n=7; all US focused), and/or treatment facility (academic/non-academic/community) (n=7; all US focused). Studies were most often excluded for incorrect population or outcome. Both studies investigating the impact of SES reported that higher SES was associated with significantly improved OS. The majority of studies reported that patients with private insurance had significantly improved OS compared to patients with Medicare (n=4/6) or uninsured patients (n=3/5). Treatment in an academic facility was significantly associated with improved OS compared to non-academic and/or community facilities in most studies (n=4/7).


Findings from this SLR suggest that higher SES, private insurance, and treatment in an academic facility are associated with improved OS in patients with mPC. Focused efforts are needed to understand this survival advantage and to expand the benefit to all patients.

Conference/Value in Health Info

2023-05, ISPOR 2023, Boston, MA, USA

Value in Health, Volume 26, Issue 6, S2 (June 2023)




Health Policy & Regulatory

Topic Subcategory

Health Disparities & Equity


No Additional Disease & Conditions/Specialized Treatment Areas

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