About

Deborah R Kaye is an Associate Professor of Urology and an Associate Professor in Population Health Sciences at Duke University. She is a member of the Duke Clinical Research Institute, the Duke Cancer Institute Core Faculty, and the Duke-Margolis Institute for Health Policy. Her professional roles involve contributions to urology, clinical research, and health policy, with her office located at 20 Medicine Circle, Durham, NC 27710. She is engaged in education and training through the Duke Urologic Oncology Fellowship and the Urology Residency Program, and her work is integrated within Duke's broader medical and research community.

Research topics

• Medicine
• Medical physics
• Pathology
• Gynecology
• Finance
• Emergency medicine
• Medical emergency
• Internal medicine
• Oncology
• Nursing

Selected publications

• Price transparency & out-of-pocket payments for medications: Implications of associated delivery fees in the United States

  Health Policy OPEN · 2026-01-26

  articleOpen access1st authorCorresponding

  • We examine payments for drugs alone compared to payments for drug and delivery fees required for drug administration. • Price transparency for drugs currently only includes payments for drug alone. • While there are substantial differences in OOP payments for first-line treatments of drugs alone, when including additional payments associated with drug delivery, payments across first-line treatments are more similar. • The amount a patient pays to receive a medication for mCRPC can be very different from the OOP payment for drug alone, thus impacting the potential effectiveness of price transparency. Price transparency has been cited as a tool to reduce out-of-pocket (OOP) payments to patients. These tools for prescription drugs often focus on the price to patients for the drug alone. However, costs associated with drug delivery (i.e. infusion center fees, labs, etc) are often unknown and could impact the effectiveness of price transparency tools. Objective: To examine total OOP payments on day of drug receipt (“full day”, i.e. drug + drug administration fees) out-of-pocket (OOP) payments associated with six first-line treatments for metastatic castrate resistant prostate cancer and compare these with payments for drug alone and by insurance type. Using the IBM Marketscan databases, we identify male patients who initiated treatment with one of six focus drugs (docetaxel, abiraterone, enzalutamide, sipuleucel-T, cabazitaxel, and radium-223) used to treat mCRPC from 07/01/2013–06/30/2019. We calculated total OOP payments on day of drug receipt (full day OOP payments) by drug type for six first line treatments. We then used a two-part model to assess the association of first-line therapy with OOP payments for the four most frequently prescribed during the study time period. We find that there is variation in the proportion of payments for drug alone relative to full day payments across first-line treatments. However, regression-adjusted mean full day OOP payments are not statistically different across first-line treatments for mCRPC for the four most frequently prescribed drugs. There are differences in the likelihood that an individual will incur any OOP payment by first-line treatment type and by health plan type. These analyses suggest that when accounting for additional services required on the day of drug receipt, the amount a patient pays to receive a medication for mCRPC can be very different from the OOP payment for the drug alone; these payments also vary by drug and health plan type. Therefore, price transparency for drug alone may not lead to reduced OOP payments for patients.

  PublisherDOI

• IP04-33 IMPROVING OUTCOMES OF PATIENTS WITH ADVANCED PROSTATE CANCER THROUGH A BETTER UNDERSTANDING OF CLINICAL FACTORS CONTRIBUTING TO FINANCIAL TOXICITY: A QUALITATIVE STUDY

  The Journal of Urology · 2025-04-08

  articleSenior author
  PublisherDOI

• MP05-20 PERIOPERATIVE OUTCOMES OF CONSOLIDATIVE SURGERY FOLLOWING IMMUNOTHERAPY WITH PEMBROLIZUMAB PLUS ENFORTUMAB VEDOTIN FOR ADVANCED UROTHELIAL CANCER

  The Journal of Urology · 2025-04-08

  article
  PublisherDOI

• Understanding the Causes of Nonadherence to Chronic Medications Among Patients With Cancer and Multimorbidity: A Qualitative Study 

  Journal of General Internal Medicine · 2025-12-09 · 1 citations

  articleOpen access1st authorCorresponding
  PublisherOA PDFDOI

• Reply to Editorial Comment: Physician Perspectives on the Nonclinical Factors That Contribute to Decision-Making for Advanced Prostate Cancer Care: A Qualitative Study

  JU Open Plus · 2024-06-01

  editorialOpen accessSenior author

  We appreciate the kind comments of Strup and Harris on our qualitative study.1,2 We agree that there is a significant discrepancy between the clinical aspects of decision making for patients with prostate cancer and the realities of a complex health care system. We hope that by shedding light on some of these barriers, we are one step closer to developing patient goal-concordant tools, guidelines, and policies. Furthermore, our study emphasizes the need for a better understanding of the knowledge and roles of the clinical support staff who are integral to addressing and overcoming the barriers identified in our study. Only with an appreciation for the knowledge of patients, clinicians, and clinical support staff can we create an optimized care system.

  PublisherDOI

• Real-world economic burden of metastatic castration-resistant prostate cancer before and after first-line therapy initiation

  Journal of Medical Economics · 2024-01-11 · 8 citations

  articleOpen access1st author

  Aims:To describe healthcare costs of patients with metastatic castration-resistant prostate cancer (mCRPC) initiating first-line (1 L) therapies from a US payer perspective.Methods: Patients initiating a Flatiron oncologist-defined 1 L mCRPC therapy (index date) on or after mCRPC diagnosis were identified from linked electronic medical records/claims data from the Flatiron Metastatic Prostate Cancer (PC) Core Registry and Komodo's Healthcare Map.Patients were excluded if they initiated a clinical trial drug in 1 L, had <12 months of insurance eligibility prior to index, or no claims in Komodo's Healthcare Map for the Flatiron oncologist-defined index therapy.All-cause and PC-related total costs per-patient-per-month (PPPM), including costs for services and procedures from medical claims (i.e.medical costs) and costs from pharmacy claims (i.e.pharmacy costs), were described in the 12-month baseline period before 1 L therapy initiation (including the baseline preand post-mCRPC progression periods) and during 1 L therapy (follow-up).Results: Among 459 patients with mCRPC (mean age 70 years, 57% White, 16% Black, 45% commercially-insured, 43% Medicare Advantage-insured, and 12% Medicaid-insured), average baseline all-cause total costs (PPPM) were $4,576 ($4,166 pre-mCRPC progression, $8,278 post-mCRPC progression).Average baseline PC-related total costs were $2,935 ($2,537 pre-mCRPC progression, $6,661 post-mCRPC progression).During an average 1 L duration of 8.5 months, mean total costs were $13,746 (allcause) and $12,061 (PC-related) PPPM.The cost increase following 1 L therapy initiation was driven by higher PC-related outpatient and pharmacy costs.PC-related medical costs PPPM increased from $1,504 during baseline to $5,585 following 1 L mCRPC therapy initiation.Limitations: All analyses were descriptive; statistical testing was not performed.Conclusion: Incremental costs of progression to mCRPC are significant, with the majority of costs driven by higher PC-related costs.Using contemporary data, this study highlights the importance of utilizing effective therapies that slow progression and reduce healthcare resource demands despite the initial investment in treatment costs. PLAIN LANGUAGE SUMMARYProstate cancer is one of the most common causes of cancer death in men.While outcomes are good if treated early, some patients may develop advanced disease that is more difficult and costly to treat.The most advanced form is late-stage hormone-resistant prostate cancer.Previous studies found that healthcare costs and use of medical services increase when prostate cancer advances to this stage.New medications are available, but their costs are not well known.Our study reviewed clinical information and health insurance data to estimate the healthcare costs and medical services used by 459 men who received drug treatment for late-stage hormone-resistant prostate cancer between 2017 and 2021 in the United States.In the year before a diagnosis and the start of drug treatment for late-stage hormoneresistant prostate cancer, total healthcare costs per month were approximately $4,000.After diagnosis of but before drug treatment for late-stage hormone-resistant prostate cancer, monthly healthcare costs nearly doubled, to approximately $8,000.Most of the additional $4,000 were specifically related to prostate cancer.After the start of the first drug treatment, total healthcare costs increased to approximately $13,500 every month.Most of the costs were related to medical office/clinic visits and medications.As their disease progressed, men received additional therapies, and office/clinic visits and use of chemotherapy also increased.These results emphasize the high healthcare costs and large number of medical services used by men with late-stage hormone-resistant prostate cancer.Therapies that slow progression to advanced prostate cancer may help to reduce high healthcare costs.

  PublisherOA PDFDOI

• Abstract 3410: Financial toxicity among patients with advanced prostate cancer in the United States

  Cancer Research · 2024-03-22

  article

  Abstract Background: Advanced prostate cancer is defined as metastatic hormone-sensitive prostate cancer (mHSPC) or castration-resistant prostate cancer (CRPC). Newer and aggressive treatments are leading to increasing lifespans in this population. As such, studying quality of life could have a large impact on the survivorship experience. An important component of quality of life is financial toxicity, defined as the financial burden and distress that can arise for patients and their families because of cancer treatment. Objectives: To understand the prevalence and predictors of financial toxicity in advanced prostate cancer. Methods: IRONMAN (International Registry of Men with Advanced Prostate Cancer) is a prospective cohort of patients with newly diagnosed mHSPC or CRPC enrolling in 15 countries. Financial toxicity was collected using the EORTC QLQ-C30 (“has your physical condition or medical treatment caused you financial difficulties?”) at enrollment and every three months thereafter. For this analysis, we studied 997 patients cared for at 37 US sites enrolled from 7/2017 to 7/2023. We examined baseline and longitudinal reports of financial toxicity across clinical and demographic factors: age at enrollment, race and ethnicity, disease state, marital status, education, employment, military status, and type of health center. We conducted adjusted risk difference analysis and multivariable regression modeling to identify predictors of financial toxicity using a generalized estimating equations approach to calculate odds ratios (OR and 95% confidence intervals, CI). Results: At enrollment, 125 (13%) patients reported experiencing “quite a bit” or “very much” financial toxicity. 21% of Black patients experienced toxicity compared to 10% of White patients. Even after incorporating all other predictors, Black patients experienced 5% (95% CI: 0, 11) greater toxicity than White patients. Independently of other predictors, patients &amp;gt;75 experienced 11% (CI: -17, -4) lower toxicity compared to those &amp;lt;65 years (while patients in the 65-74 group experienced 6% less, CI: -12, 1). Toxicity was 6% greater in patients with mHSPC (CI: 2, 10) than in patients with CRPC, and disabled or unemployed patients were at substantially higher risk. In the multivariable longitudinal analyses, older age (&amp;gt; 75) remained associated with significantly lower odds for financial toxicity (OR: 0.30, 0.15-0.61) while mHSPC (OR: 1.91, 1.14-3.20) and being unemployed (OR: 2.69, 1.03-6.99) or disabled (OR: 5.14, 2.29-11.6) were associated with higher odds. Conclusions: Financial toxicity is prevalent in advanced prostate cancer, especially in patients who are Black, younger than 75, diagnosed with mHSPC, or unemployed/disabled. These results may inform identification of patients at high risk for financial toxicity to support delivery of patient-situation-informed care by clinicians and targeted aid for patients at highest risk. Citation Format: Isani Singh, Bailey Vaselkiv, Emily Rencsok, Karen Autio, Deborah Enting, Alicia Morgans, Joel Nowak, Kevin Kensler, David Nanus, Robert Dreicer, Brian Lewis, Oliver Sartor, Elisabeth Heath, Phillip Kantoff, Deborah Kaye, Daniel George, Lorelei Mucci. Financial toxicity among patients with advanced prostate cancer in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3410.

  PublisherDOI

• Reply to Editorial Comment: Physician Perspectives on the Nonclinical Factors That Contribute to Decision-Making for Advanced Prostate Cancer Care: A Qualitative Study

  JU Open Plus · 2024-04-01

  editorialOpen access1st authorCorresponding

  We appreciate the kind comments by Dr. Obiora and Dr. Jacobs on our article examining nonclinical factors that affect physician decision-making for patients with advanced prostate cancer. Patient factors, such as race, geographic distribution, and physician specialty have been shown to create treatment variation for these patients.1 Provider insights, however, regarding the factors that create treatment disparities for patients with advanced prostate cancer have been woefully understudied. Our article sheds light on this knowledge gap by revealing 3 themes and 17 domains that influence physician decision-making.2 While we attempted to enroll physicians from all regions of the United States, we acknowledge that the use of a snowball technique likely contributed to lower enrollment from the western part of the country. Although we recruited fewer rural providers in this study as well, it is important to consider that 76% of rural counties in the United States do not have a practicing urologist.3 This does not mean that we did not sample urologists that take care of rural patients, however, as it is unfortunately common that patients from rural areas have to travel to suburban or urban health care centers for urological care. As such, we agree that the absence of rural urologists likely did not have a profound impact on our results as geographical distribution of the patient with prostate cancer likely has a more significant effect than the practice location of the urologist. We agree with Dr. Obiora and Dr. Jacobs that the impact of the prior authorization process on the treatment of patients with advanced prostate cancer is profound and disheartening.4 It is evident that the prior authorization process affects treatment decisions, consumes considerable practice resources, and delays treatment.2 We hope that this study will draw attention to these challenges, as well as other patient, clinician, and practice factors that affect decision-making, thus contributing to clinicians not being able to successfully offer patients certain treatment types, unwarranted variation, and health care disparities. This work will also hopefully lay the groundwork for additional research and intervention development, allowing for impactful change for patients and clinicians in the future.

  PublisherDOI

• MP33-15 DIFFERENTIAL RECEIPT AND COMPLETION OF A UROLOGY REFERRAL SUBSEQUENT TO AN ELEVATED SCREENING PSA TEST

  The Journal of Urology · 2024-04-15

  article

  You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety II (MP33)1 May 2024MP33-15 DIFFERENTIAL RECEIPT AND COMPLETION OF A UROLOGY REFERRAL SUBSEQUENT TO AN ELEVATED SCREENING PSA TEST Rand Wilcox Vanden Berg, Deborah Kaye, Andrew Stirling, Patti Gorgone, Shwetha Dash, Jillian Hurst, Anna Xu, Benjamin Goldstein, Armando Bedoya, Nrupen Bhavasa, Gabbriella Brenman, Hannah McManus, and Matthew Labriola Rand Wilcox Vanden BergRand Wilcox Vanden Berg , Deborah KayeDeborah Kaye , Andrew StirlingAndrew Stirling , Patti GorgonePatti Gorgone , Shwetha DashShwetha Dash , Jillian HurstJillian Hurst , Anna XuAnna Xu , Benjamin GoldsteinBenjamin Goldstein , Armando BedoyaArmando Bedoya , Nrupen BhavasaNrupen Bhavasa , Gabbriella BrenmanGabbriella Brenman , Hannah McManusHannah McManus , and Matthew LabriolaMatthew Labriola View All Author Informationhttps://doi.org/10.1097/01.JU.0001009520.30626.80.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate cancer is the most common non-cutaneous cancer affecting men in the United States. Notably, non-Hispanic Black patients are more likely to be diagnosed with prostate cancer and have higher prostate cancer mortality compared to non-Hispanic White patients, While prostate-specific antigen (PSA) screening has been shown to decrease mortality, without a referral to the proper specialist, this benefit cannot be obtained. We analyzed the urology referral and completion of referral pattern for patients with elevated PSA screening tests at our institution and herein report factors associated with being referred for subsequent workup and the completion of such referral. METHODS: Data for patients aged 40-75 undergoing PSA screening from 1/1/2018 through 12/31/2022 were collected from institutional data. PSA results were corrected for 5-alpha reductase inhibitor use and were categorized as elevated based off of institutional policies (age 40-49, ≥ 1.5 ng/mL; 50-69, ≥ 3.0 ng/mL; ≥70, ≥ 6.5 ng/mL). Patients with elevated PSA results were then categorized as having received a referral to urology or not within 90 days of the test result. Patients that received a referral were categorized as having completed the referral if a visit was completed within our institution. Baseline characteristics were described. Multivariable log link models stratified by race were calculated for referral and completion of referral and adjusted for age, previously elevated PSA, insurance status, and healthcare utilization within prior 18 months. p values of 0.05 were considered statistically significant. RESULTS: A total of 9874 patients with elevated PSA results were included. Baseline characteristics between those that were and were not referred are presented in Table. 3250 (32.9%) were referred of which 2157 (66.4%) completed their referral internally. Modeling for receiving a referral, adjusted for age, insurance status, and prior abnormal PSA levels, showed that non-Hispanic Black patients (HR 1.426, 95% CI 1.35-1.51), Hispanic patients (HR 1.34, 95% CI 1.17-1.54), and patients with other or unavailable race (HR 1.27, 95% CI 1.17-1.39) were more likely to receive a referral when compared to non-Hispanic White patients. When looking at referral completion, however, non-Hispanic Black patients were less likely to complete the referral (HR 0.95, 95% CI 0.91-0.99); there was no difference for Hispanic patients (HR 1.05, 95% CI 0.96-1.15) or patients with other or unavailable race (HR 0.98, 95% CI 0.92-1.04). CONCLUSIONS: In our cohort, we found that when adjusting for demographic variables, Non-Hispanic Black, Hispanic, and patients reported as other were more likely to be referred for an elevated screening PSA when compared to non-Hispanic White patients. Non-Hispanic Black patients, however, were slightly less likely to complete a referral while Hispanic patients and patients reported as other were equally likely. These data suggest that more studies are needed to identify the cause of such disparate referral pattern and discover the reasons for patients not completing referrals for elevated PSA results, with the goal of establishing targeted interventions to improve urology appointment completion and ultimately patient outcomes. Source of Funding: Duke internal funds © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e566 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Rand Wilcox Vanden Berg More articles by this author Deborah Kaye More articles by this author Andrew Stirling More articles by this author Patti Gorgone More articles by this author Shwetha Dash More articles by this author Jillian Hurst More articles by this author Anna Xu More articles by this author Benjamin Goldstein More articles by this author Armando Bedoya More articles by this author Nrupen Bhavasa More articles by this author Gabbriella Brenman More articles by this author Hannah McManus More articles by this author Matthew Labriola More articles by this author Expand All Advertisement PDF downloadLoading ...

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• Perspectives on Neoadjuvant Clinical Trial Participation for Patients with Kidney Cancer: A Survey-Based Examination

  Kidney Cancer · 2024-02-29

  articleOpen accessSenior author

  Background: Kidney cancer is amongst the deadliest genitourinary malignancies. Neoadjuvant systemic therapy has the potential to improve survival and overall outcomes in select patients. Enrolling patients in trials of neoadjuvant treatment for kidney cancer is challenging, which limits neoadjuvant treatment development. Objective: This study aims to develop a better understanding of the barriers patients face in kidney cancer clinical trial participation, with a particular focus on neoadjuvant trials for renal cell carcinoma. Methods: From 2022–2023, we recruited participants with a history of kidney cancer through a Qualtrics survey that was sent to the Kidney Cancer Association (KCA) and Kidney Cancer Cure (KCCure) mailing lists and social media pages. Patient responses on demographics, clinical information, and perspectives were evaluated. Results: Ninety-four individuals completed the survey. Eighty-one percent of respondents reported not participating in clinical trials due to not being informed about potential applicable trials. Importantly, many (76%) respondents reported that prevention of cancer return was a highly important reason to participate in clinical trials. Most respondents reported a willingness to undergo a kidney biopsy (59%), and/or additional appointments (58%) and surgery delays. Conclusions: Increased patient awareness about clinical trials with the potential to delay cancer recurrence may increase patient participation in clinical trials. Clinical trial design, including additional appointments or interventions and/or minor surgery delays are not major barriers to trial participation.

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Frequent coauthors

• Charles D. Scales

  81 shared

• Tian Zhang

  University of Utah

  43 shared

• Daniel J. George

  Duke Cancer Institute

  38 shared

• Michaela A. Dinan

  Yale University

  32 shared

• Vishnukamal Golla

  28 shared

• James M. Dupree

  University of Michigan–Ann Arbor

  27 shared

• Michael E. Lipkin

  Duke Medical Center

  27 shared

• Ian Berger

  Duke Medical Center

  27 shared