MP39-16: Impact of High-Grade Radiation Injury Following Prostate Cancer Radiation on Healthcare Cost and Utilization

Kevin Hebert*, Joshua Horns, Nathan Driggs, Rupam Das, Rano Matta, Benjamin McCormick, Salt Lake City, UT, James Hotaling, Salt Lake City , UT, Jeremy Myers, Salt Lake City, UT

Introduction: High-grade radiation injuries (HGRI) following treatment of prostate cancer with radiation are often chronic and require multiple interventions. We investigated the fiscal impact and impact on healthcare resource utilization following HGRI.

Methods: We performed a retrospective study of men diagnosed with prostate cancer who were treated with radiotherapy and subsequently developed HGRI (defined by Common Terminology Criteria for Adverse Events) using IBM MarketScan, a large commercial claims database. Exclusion criteria included any other genitourinary malignancy, metastatic disease, or low grade radiation injury. Diagnoses and interventions were identified using ICD9/10 codes and common procedural terminology codes, respectively. HGRI of interest included: bladder neck stenosis, hematuria/cystitis, urinary fistula, ureteral stricture, and urinary incontinence. We ran negative binomial regressions to assess the effect of HGRI on healthcare use adjusting for demographics and comorbidities. Associated outpatient, inpatient, and pharmacologic costs incurred from time of high-grade radiation injury diagnosis to 1 year following the first intervention were assessed for each cohort.

Results: Between 2008-2017 we identified 155,685 men who received radiotherapy for a prostate cancer diagnosis. Of these men, 13,387 patients experienced a HGRI. Compared to men without injury, the rate of inpatient services utilized per 1000 person-months was higher in men diagnosed with high-grade bladder neck stenosis 1.59 [95% CI, 1.4-1.8], hematuria/cystitis 1.7 [1.6-1.9], ureteral stricture 3.1 [2.6-3.7], urinary fistula 5.0 [2.3-11.1], and urinary incontinence 1.5 [1.3-1.9]. Likewise, compared to men without injury, the rate of outpatient services utilized per 1000 person-months was higher in men diagnosed with high-grade bladder neck stenosis 1.8 [95% CI, 1.6-1.9], hematuria/cystitis 1.9 [1.7-2.0], ureteral stricture 2.1 [1.8-2.4], urinary fistula 2.5 [1.3-4.8], and urinary incontinence 1.8 [1.5-2.1]. Median inpatient costs per month from time of injury diagnosis to 1 year following first intervention was $558 (bladder neck stenosis), $484 (hematuria/cystitis), $684 (ureteral obstruction), $927 (urinary fistula), and $554 (urinary incontinence).

Conclusions: Significant healthcare utilization occurs following HGRI at significant cost to the patient. Further study is necessary to fully characterize the impact of resource utilization in those who develop HGRI following prostate cancer treatment.

Source of Funding: N/A