1012 - Association between Rectal Spacer Use and Long-Term Health Care Costs: Payer Perspective

Purpose/Objective(s): Rectal spacer (RS) use in prostate cancer (PCa) patients undergoing radiotherapy (RT) may reduce long-term healthcare costs by mitigating treatment-related complications. At the same time, patients with RS may represent a high-cost medical care-seeking cohort. The economic impact of RS remains underexplored using real world data. This study evaluates the association between polyethylene glycol hydrogel RS use and long-term healthcare costs from a payer perspective.

Materials/Methods: A retrospective cohort study was conducted using Medicare 5% Standard Analytic Files and the Merative™ MarketScan® Commercial Database. PCa patients who received RT between 2015 and 2020 with continuous enrollment from one year pre-RT to four years post-RT were included; those undergoing prostatectomy were excluded. The outcome was total insurer-paid healthcare costs before, during, and after RT, comparing patients with and without RS. A Generalized Linear Model (GLM) assessed cost differences, adjusting for age, comorbidities, baseline dysfunction (bowel, sexual, urinary), secondary cancer, RT modality, data source, treatment year, and state fixed effects.

Results: Among 5,829 PCa patients undergoing RT, 270 (4.6%) underwent RS. RS patients were more likely to undergo stereotactic body RT (20.7% vs. 8.5%, p<0.001) and less likely to receive intensity-modulated RT (37.8% vs. 57.5%, p<0.001). Costs 1-year pre-RT were significantly higher for RS patients ($17,378 vs. $15,567, p=0.023), as were costs for RT + RS at the time of treatment by $3,949 ($31,712 vs. $27,763, p<0.001). However, at four years post-RT, total insurer-paid costs were significantly lower for RS patients by $8,095 ($52,345 vs. $60,440, p=0.011). Costs related to bowel, sexual, and urinary dysfunctions were also lower by $4,109 ($6,698 vs. $10,807, p=0.009).

Conclusion: Patients undergoing PCa RT with RS were associated with significantly lower long-term healthcare costs despite higher healthcare utilization in the RS group at baseline. These differences may be due to underlying patient selection factors. Nonetheless, these findings highlight the potential economic impact of RS placement from a payer perspective.