Optimizing the Systemic Treatment for Metastatic Castration-Resistant Prostate Cancer in Lower-Middle-Income...

Prostate cancer is the most prevalent cancer in men worldwide. As new treatments become available, costs also increase, and patients from lower-middle-income countries do not have access to those treatments due to cost restriction and governmental approval. However, several non-survival-prolonging treatments (nspTx) continue to be offered to patients with metastatic castration-resistant prostate cancer (mCRPC).

We gathered retrospective data from patients with mCRPC treated under the Brazilian Public Health System (BPHS) from 2017 to 2023. Our analysis concentrated on assessing the treatment plans, the median duration of treatment (mDoT), and the costs associated with these plans. The main aim of this study was to clarify the overall expenses, timing, and types of therapies provided to patients with mCRPC.

A cohort of 38,851 patients with mCRPC showed a mDoT of 20.5 months and total castration-resistant treatment costs of $333,200,939 US dollars (USD). Among them, 31,430 (81%) received survival-prolonging treatments (spTx), while 7,421 (19%) were given nspTx. The spTx group had a mDoT of 19.8 months, with total spending of $269,892,761 USD and an average cost per patient of $8,587.11 USD. The nspTx group's mDoT was 20.5 months, costing $63,308,180 USD in total and $8,530.95 USD per patient. Exploratory analysis indicated that funds spent on nonsurvival treatments for one patient could cover generic cabazitaxel (20 mg/m² once every 21 days, six cycles) for approximately two patients with mCRPC.

This long-term analysis of the BPHS treatment of mCRPC shows substantial spending on spTx and nspTx. Although most patients received recommended spTx, 19% received nspTx at similar costs. Results indicate the need for reforms to prioritize evidence-based treatments in resource-limited settings.