ESMO 2017: Medical Costs and Health Care Resource Use in Elderly US Patients With Newly Diagnosed Metastatic or Surgically Unresectable Urothelial Carcinoma Using Surveillance, Epidemiology, and End Results (SEER) Medicare Data

Madrid, Spain ( Dr. Aly and colleagues presented their results of medical costs and health care use among elderly patients with metastatic urothelial carcinoma at today’s poster session at ESMO 2017. Most elderly metastatic urothelial carcinoma patients receive platinum-based therapy as first line of treatment but invariably progress, requiring additional lines of treatment and health care resource use. The objective of this study was to estimate medical costs and health care resource use associated with each line of treatment in US elderly patients with metastatic urothelial carcinoma.

Patients ≥66 years of age newly diagnosed with metastatic urothelial carcinoma between 2004 and 2011 were identified from the SEER-Medicare database. Patients were followed from diagnosis to death, Medicare disenrollment, HMO enrollment, or until December 31, 2013 to characterize treatments by line of treatment (first, second, and third + lines of treatment).

Cumulative mean costs (overall and by type of line of treatment) were reported. Among 1,873 eligible metastatic urothelial carcinoma patients (median age, 77 years; male, 63%; Charlson comorbidity index ≥2, 29%; median follow-up, 7.5 months), 1,035 (55%) patients did not receive any chemotherapy. Among the 838 chemotherapy-treated pts, 510 (61%), 204 (24%), and 124 (15%) received first, second, and third + lines of treatment, respectively. Compared with second line of treatment, third + lines of treatment patients had significantly higher mean (SD) per-patient hospital admissions (4.1 [2.9] vs 4.8 [3.3]), CT scans (7.4 [4.4] vs 9.9 [5.8]), PET–CT scans (1.0 [1.5] vs 2.0 [2.9]), and bone scans (1.1 [1.1] vs 1.8 [2.3]). The total unadjusted costs incurred during each line of treatment were: line of treatment 0: $41,126; line of treatment 1: $49,969; line of treatment 2: $37,592; line of treatment 3: $36,084. Patients who received third + lines of treatment had significantly higher cumulative mean costs than second line treatment patients, mostly attributed to physician and outpatient services where chemotherapy is administered.

In summary, for patients with metastatic urothelial carcinoma, cumulative mean costs increased with additional line of treatment, although further analysis of cumulative costs over the treatment duration of each line of treatment is warranted. As the treatment landscape evolves to include immunotherapy, this analysis provides a benchmark for the relative costs associated with metastatic urothelial carcinoma treatment across different traditional lines of treatment in the United States.

Speaker: Abdalla Aly, National Cancer Institute, Bethesda, United States of America

Co-Authors: C. Johnson (Bethesda, United States of America) S. Yang (Princeton, United States of America) S. Rao (Princeton, United States of America) M. Botteman (Bethesda, United States of America) A. Hussain (Baltimore, 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