OBJECTIVES: To compare the inpatient (IP) and outpatient (OP) costs and healthcare resource use (HCRU) of metastatic prostate cancer (mPC) patient admissions versus non-mPC patient admissions (nmPC) in the hospital setting

METHODS: IP and OP admissions with a primary diagnosis of prostate cancer (PC) (ICD 9-185 and ICD 10-C61) from the Premier Perspective Hospital Database (June 2010 - September 2016) were included. Admissions of adult PC patients were divided into 2 cohorts based on the presence or absence of metastasic codes at discharge (ICD codes indicating bone, lymph or visceral metastases were included). Differences in PC related HCRU and costs across IP and OP settings were analyzed using generalized linear models (GLM) controlling for patient characteristics.

RESULTS: A total of 78,667 IP (4,576 with mPC) and 8,74,366 OP (71,545 with mPC) admissions with PC were included. Among the mPC IP admissions, 72.6% were ≥ 65 yrs (mean age for mPC was 72 yrs compared to 63 yrs for nmPC) and 77.5% had bone metastases. Mean total cost per admission for IP admissions inclusive of pharmacy, laboratory, diagnostic imaging, radiation therapy, nuclear medicine and surgery costs was $12,324 (Standard Deviation (SD) $13,506) for mPC and $10,987 (SD $6,912) for nmPC. Mean length of stay was higher among mPC (6 days (SD 6.9)) compared with nmPC (2 days (SD 2.4)) admissions. Adjusted GLM analysis showed that the mean total cost was significantly higher for the mPC (mean difference $1,293, 95%CI $1,063-$1,522) admissions compared with nmPC admissions. Results were similar for OP setting with a mean total cost of $1,626 for mPC compared with $909 for nmPC.

CONCLUSIONS: This study highlights the key differences in the economic burden of mPC admissions for both IP and OP, from a hospital perspective. There is a need for treatment strategies that delay the progression to metastasis.