For this study, patients ≥65 years of age with an initial diagnosis of metastatic bladder cancer between January 2007 and December 2011 were retrospectively identified using SEER-Medicare linked data and followed for a minimum of 24 months until December 2013. Annual survival rates were calculated for treated and untreated patients. Patients were categorized into one of three mutually exclusive treatment groups (cisplatin-based, carboplatin-based, or nonplatinum-based) according to the chemotherapy regimen they received for first-line and second-line therapy. Total costs were estimated during the treatment exposure window for healthcare visits and treatment for metastatic bladder cancer-related, adverse event-related, and other costs. All costs were converted to 2016 US dollars.
There were 1,215 patients with metastatic bladder cancer at diagnosis, of which 804 (66.2%) patients received no first-line treatment and 411 (33.8%) patients received first-line therapy and 189 (46.0%) patients subsequently received second-line therapy. The most common first-line regimen was carboplatin-based regimens (45.0%), and most common second-line regimen was nonplatinum based regimens (50.8%). For all first-line treated patients, the 1, 2, and 3-year survival rates from metastatic bladder cancer were 56.5%, 25.6%, and 15.5%, respectively, compared to 12.9%, 6.0%, and 4.7% for untreated patients, respectively. For second-line patients, the 1, 2, and 3-year survival rates from second-line treatment initiation were 32.8%, 14.9%, and 7.7%, respectively. The total costs of cancer during the first and second-line treatment windows were $36,793 for first-line treatment and $26,732 for second-line treatment, corresponding to $12,503 and $11,671 spent per-patient-per-month, respectively. Importantly, the patient was responsible for $5,902 of total first-line treatment costs, and $4,267 for second-line treatment costs. For all regimens, the highest per-patient cost occurred in the outpatient setting, followed by emergency, inpatient, skilled-nursing facility, and lastly hospice. Care from metastatic bladder cancer accounted for >50% of the cost with the remainder of cost attributed to adverse events and other costs.
In conclusion, patients with metastatic bladder cancer had poor survival outcomes, particularly for untreated patients. Less than half of patients received guideline-endorsed first-line chemotherapy. Cancer-related outpatient and emergency health care utilization were primary drivers of the per-patient economic burden. Finally, the authors concluded that total costs of care for metastatic bladder cancer, including adverse-event related and all other costs, should be weighed against the clinical outcomes likely to be achieved with any therapeutic option.
Speaker: Kyle Flannery, Merck & Co., Kenilworth, United States of America
Co-Authors: X. Cao (North Wales, United States of America) J. He (North Wales, United States of America) Y. Zhong (North Wales, United States of America) A. Y. Shah (Houston, United States of America) A. Kamat (Houston, United States of America)
Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, Twitter: @zklaassen_md at the European Society for Medical Oncology Annual Congress - September 8 - 12, 2017 - Madrid, Spain