Retrospektive GKV-Versorgungsforschungsstudie über GnRH-Antagonisten/-Agonisten zur initialen Therapie des fortgeschrittenen Prostatakarzinoms - Verordnungsmuster und Krankenhauskosten in Deutschland

Translated title of the contribution: Retrospective SHI (Statutory Health Insurances) real-world study on initial GnRH antagonist and agonist therapy for advanced prostate cancer: Prescription patterns and hospital costs in Germany

Marie Christine Hupe*, Peter Hammerer, Miriam Ketz, Nils Kossack, Christiane Colling, Axel S. Merseburger

*Corresponding author for this work

Abstract

Introduction: Androgen deprivation therapy (ADT) plays a pivotal role in the treatment of advanced or metastasised prostate cancer (PCa). The aim of this health services research was to compare real-world data on the initial use of different GnRH agonists and antagonists (GnRHa) with regard to prescription patterns, hospitalisation rates and costs. Material and methods: Anonymised claims data from>70 German health insurance funds between 2010 and 2015 (n=4205227) were analysed (1 year pre-observation period, 1 index quarter with initial GnRHa prescription,≥2 years of follow-up (FU)). Results: The study population included 2382 PCa patients (mean age 75 years). Leuprolide (Leu) was prescribed most frequently (56.6%). At initial GnRHa administration, 70% of patients neither had lymph node nor distant metastases. Around 11.2% of all patients stopped GnRHa treatment after the first prescription, 17.6% switched their initial therapy to another substance after a mean of 457 days (median: 399 days); in the hybrid (hyb) group 100 days earlier on average than in the agonist group (p=0.016). The prevalence ranking of the most common comorbidities was consistent over time: hypertension, hyperlipidaemia, cardiovascular disease (CVD) and diabetes. The prevalence of hypertension increased significantly in the agonist group (16.4%) compared with the antagonist (6.9%, p=0.022) and hyb group (11.6%, p=0.006). With regard to CVD, there were no significant differences in the relative growth rate between the 3 combined therapy classes. In total, 23.9% of all patients died within the 3-year FU. The mortality rate was lowest for triptorelin (Trp, 22.1%) and highest for goserelin (Gos, 29.4%, n.s.). In the index quarter, 26.4% of patients had at least one inpatient hospitalisation [min-max: Trp 22.4%; Gos 30.3%], with an average length of hospital stay/patient of 3 days [Trp 2.4; Gos 4.5]. The annual hospitalisation rate was between 36.2 and 40.7%, the average length of hospital stay in the entire FU was between 17.6 (Trp) and 20.8 days (hyb). The average hospital costs in the index quarter were approx. EUR 1200 [Trp 988; Gos 1803] and per FU year approx. EUR 3000. In the Trp cohort, total costs (index quarter+3 years) were more than EUR 1000 below the average costs of EUR 9476 [Trp 8116; Leu 9779; n.s.]. Conclusion: This comparative retrospective analysis provides real-world information on initial GnRHa treatment for advanced prostate cancer, revealing differences in treatment patterns, hospitalisation rates and hospital costs in Germany.

Translated title of the contributionRetrospective SHI (Statutory Health Insurances) real-world study on initial GnRH antagonist and agonist therapy for advanced prostate cancer: Prescription patterns and hospital costs in Germany
Original languageGerman
JournalAktuelle Urologie
Volume51
Issue number3
Pages (from-to)275-284
Number of pages10
ISSN0001-7868
DOIs
Publication statusPublished - 01.06.2020

Research Areas and Centers

  • Research Area: Luebeck Integrated Oncology Network (LION)

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