Using real-world data to assess variations in cost and healthcare utilization for patients diagnosed with bladder cancer.
Authors: Boehmer Leigh , Khaki Ali Raza , Carthon Bradley Curtis , Davis Nancy B. , Washington Samuel L. , Goltz Heather Honoré , Lucas Lorna , Mangir Christina 
Published: June 2022

e18815 Background: Disparities in diagnosis, treatment, and outcomes for bladder cancer in underserved patient populations persist in the United States. High out-of-pocket costs can prevent patients from seeking or continuing treatment, which can worsen existing disparities in care. The Association of Community Cancer Centers (ACCC) conducted a claims analysis of Medicare beneficiaries diagnosed with bladder cancer to assess differences in healthcare utilization and costs and to inform future provider education initiatives. Methods: ACCC convened an expert steering committee of multidisciplinary specialists and patient advocates to guide the development of the claims analysis methodology and code sets used to identify study cohorts and model variables. Using the CMS Medicare 100% Innovator Administrative Claims Data Set, incident patients were defined as those newly diagnosed in 2018 using a 24-month lookback to confirm no prior bladder cancer diagnosis. Claims for incident patients incurred in the time-period between 24 months prior to and 24 months following diagnosis date were analyzed to generate descriptive summaries of cohorts by severity of disease at diagnosis. Classification is defined by treatment observed within 6 months of diagnosis: No treatment, Early Stage-treated (intravesical chemotherapy), and Late-stage (one or more claims of non-intravesical systemic therapy, radiation therapy, or major bladder surgery). Results: 4,356 incident patients were identified: average age 77.7, 71% male, 56% no treatment, 15% early-stage treated, 28% late-stage. Patients diagnosed at late-stage incur 128% more allowed costs (total amount paid by Medicare and patients) on all-cause healthcare in the first year after diagnosis than early-stage patients who receive treatment ($76,483 vs $33,530) and 101% higher cumulative costs two years following diagnosis ($112,178 vs $55,814). Patients diagnosed at late-stage incur 90% more out-of-pocket costs (copays, coinsurance, deductibles) in the first year following diagnosis than early-stage treated patients ($9,970 vs $5,225) and 81% higher cumulative out-of-pocket costs two years following diagnosis ($15,145 vs $8,390). For both early- and late-stage patients, the month of diagnosis is the most expensive. 53% of all costs incurred in the month of diagnosis are for cystoscopy/TURBT procedures. Elevated costs persist at levels higher than pre-diagnosis levels for at least 20 months. Among late-stage patients, treatments (surgery, radiation therapy, and systemic therapy) sum to 34% of all costs incurred in 6 months following diagnosis. Conclusions: Patients diagnosed with late-stage bladder cancer experience higher financial burden and need more resource-intensive services than those diagnosed at an earlier stage. Earlier diagnosis of bladder cancer is needed to improve patient outcomes and reduce financial burden.