Skeletal-related Events Linked With Worse Survival, Increased Costs

Jason Hoffman, PharmD, RPh

Experiencing 1 or more skeletal-related events (SREs) in men with prostate cancer and metastases in the bone are associated with reduced survival, increased health care resource utilization, and higher costs, a study published in the journal The Oncologist has shown.1

“Compared with men who have prostate cancer metastatic to the bones and no SREs, men with prostate cancer metastatic to the bones experiencing ≥1 SRE had a twofold increase in the risk for death, a twofold increase in the number of emergency department visits, and a fourfold increase in the number of hospitalizations; they also incurred an additional $21,000 in direct medical costs attributed to SREs,” the authors wrote.

For the study, researchers analyzed data from 3,297 men with prostate cancer and bone metastasis who were diagnosed between 2004 and 2009 and included in the Surveillance, Epidemiology and End Results (SEER)-Medicare database. Of those participants, 40% experienced 1 or more SREs during a median follow-up of 19 months.

Results showed men with 1 or more skeletal-related events were more than twice as likely to die compared with SRE-free men (HR, 2.29; 95% CI: 2.09-2.51). Researchers found that pathological fracture was associated with the highest risk for death (HR, 2.77; 95% CI: 2.38-3.23).

In terms of health care resource utilization and costs, the study demonstrated that emergency department visits were nearly twice as likely to occur (95% CI: 1.77-2.28) among men with 1 or more SREs, and hospitalizations were more than 3 times as frequent (95% CI: 3.20-4.40). One or more SRE was associated with $21,191 in health care costs.

“This study confirms the substantial adverse clinical and economic effects of SREs in men with prostate cancer,” the authors conclude. “Strategies to prevent SREs are potentially of high value in this patient population.”


McDougall JA, Bansal A, Goulart BHL, et al. The clinical and economic impacts of skeletal-related events among medicare enrollees with prostate cancer metastatic to bone [published online ahead of print February 10, 2016]. Oncologist. doi: 10.1634/theoncologist.2015-0327.

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