Disease management costs and healthcare resource utilization by progression health state among patients with previously untreated locally advanced or metastatic urothelial cancer.
Authors: Babcock Aram , Gao Wei , Shinde Reshma , Gao Yipeng , Wang Travis , Hua Qi , Song Yan , Signorovitch James , Zhang Shujing 
Published: February 2025

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Background:
Significant disease management cost (DMC) burden and healthcare resource utilization (HRU) have been reported for patients with advanced bladder cancer; however, available data were outdated. We estimated the real-world DMC and HRU for patients with locally advanced or metastatic urothelial carcinoma (la/mUC) receiving first-line (1L) treatment over time and by progression health state with more contemporary data.
Methods:
Patients aged ≥65 years with la/mUC receiving 1L treatment were identified from the SEER-Medicare linked database (2007–2019 [SEER]; 2007-2020 [Medicare]). Disease progression on 1L treatment was defined as the initiation of second-line treatment or the diagnosis of secondary malignancies. All-cause DMC and HRU were evaluated for all eligible patients during the pre-progression period, defined as the time from 1L initiation to date of progression or end of follow-up. For patients who progressed after 1L treatment, DMC and HRU were also assessed during the post-progression period, defined as the time from date of progression to end of follow-up. DMC were calculated as the sum of all-cause medical costs (inpatient [IP] + emergency room [ER] + outpatient [OP] costs + other medical costs not associated with these settings [e.g., skilled nursing facility]) and pharmacy (Rx) + drug administration costs, excluding the Rx and drug administration costs of la/mUC treatments. HRU included IP, ER, and OP visits, and use of radiation therapy and imaging. Costs and HRU were summarized on a per-patient per-month (PPPM) basis and stratified by time intervals: 0 to <12 months, 12 to <24 months, and 24+ months. All costs were inflated to 2023 US dollars.
Results:
Among the 1,145 patients with la/mUC who received 1L treatment, 872 (76.2%) progressed after 1L treatment. DMC (PPPM) post-progression were higher compared to pre-progression across all time intervals ($12,039 vs. $8,422 [0 to < 12 months], $5,994 vs. $3,119 [12 to <24 months], and $4,591 vs $1,743 [24+ months]) and decreased over successive time intervals for both pre- and post-progression health states. Similar findings in HRU indicate higher number of IP and OP visits in the post-progression state, except for OP visits during the 0 to <12 months interval. ER visits were similar in all but the 24+ months interval, where higher rates in the post-progression state were observed. Use of radiation therapy and imaging was higher in all intervals in the post-progression health state.
Conclusions:
DMC for la/mUC patients receiving 1L therapy were higher in the post-progression state compared with the pre-progression health state. The highest costs and HRU incurred within the first 12 months of 1L treatment initiation and disease progression. Contemporary time-varying DMC during progression health states is valuable to assess economic impact of new therapies.