Patients With Prostate Cancer Value Lower Out-of-Pocket Costs for ADT

Androgen deprivation therapy (ADT) is utilized in up to 40% of patients with prostate cancer (PCa) and has grown to include many treatment options that vary in administration, adverse event profiles, testosterone recovery and onset, and cost.

New research from a phase 3 trial that assessed preferences for key attributes of ADTs for PCa was presented at the American Urological Association 2023 Annual Meeting.

A total of 304 patients over 40 years of age with a self-reported PCa diagnosis who had health care coverage for the previous 3 years were recruited for the study through health care research panels. Each patient was given a cross-sectional survey to complete, and a discrete choice experiment assessed ADT attribute preferences.

Hierarchical Bayes models estimated attribute level preference weights, and relative importance (RI) was measured by calculating the difference between preference weights of the most and least favorable levels of each attribute standardized on a 0-100 scale. RI was compared by subgroup (ADT experience, age, race/ethnicity, PCa location, and cardiovascular comorbidities) with 2-sample t tests.

Of the total patient group, 55.3% reported organ-confined PCa and 49.0% had previously received ADT. Reducing out-of-pocket (OOP) costs from $350 to $5 per month (RI=32.7) and changing medication administration from a once-monthly injection to a daily pill (RI=21.6) were the 2 most important attributes for patients. The change in medication administration was more important to non-White men, men with cardiovascular conditions, and patients whose PCa had spread (P<.05).

Improvements in impact on sexual activity (RI=17.5) and time to testosterone recovery after ADT discontinuation (RI=16.3) were 2 to 4 times as important as reduced cardiovascular event risk (RI=7.4) and testosterone surge after treatment initialization (RI=4.5). Preferences for reduced OOP cost and improvements in impact on sexual activity and time to testosterone recovery after discontinuation differed between age groups (P<.05). RI did not vary between ADT-experienced and ADT-naïve men.

In patients with PCa who undergo ADT, OOP cost was the most important factor overall and across subgroups. Mode and time of administration were also important. Shared decision-making should take patient preference into account.