To examine characteristics associated with BCG receipt and the impact of supply shortages on BCG utilization and potential healthcare disparities, given global supply shortages have strained access since 2012.
We analyzed 16,958 adults ≥66 years with newly diagnosed high-grade non-muscle invasive bladder cancer from 2002-2017 using SEER-Medicare. We examined the associations of baseline characteristics and 3 supply shortage events (in 2012, 2014, and 2017) with BCG receipt using multivariable regression, interrupted time series (ITS) analysis, and regression discontinuity analyses.
BCG receipt increased from 37% in 2002 to 60% in 2017 in eligible patients. Overall, in multivariable analyses, later diagnosis year, higher income and education status, higher T stage, and higher annual surgeon TURBT volume were associated with increased likelihood of BCG receipt, while older age, single/widowed/divorced status, higher Charlson comorbidity index (CCI), and current/former smoking status were associated with lower likelihood. ITS and regression discontinuity analyses showed sustained growth in BCG utilization that was minimally impacted by supply shortages, aside from a significant growth acceleration after the 2014 shortage. Effect modification analyses demonstrated no consistent associations of patient or socioeconomic characteristics with supply shortage events to suggest a differential impact among specific subgroups.
From 2002-2017, BCG utilization for high-risk NMIBC significantly increased from 37% to 60%, with minimal impact from supply shortages. While baseline characteristics influenced BCG receipt, there was no consistent evidence that BCG supply shortages exacerbated existing disparities.
Urology. 2026 Apr 14 [Epub ahead of print]
David Kennedy-Yoon, Jamil Almohtasib, Sumedh Kaul, Aaron Fleishman, Peter Chang, Andrew Wagner, Joaquim Bellmunt, Ruslan Korets, Aria F Olumi, Boris Gershman
Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA., Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA., Harvard Medical School, Boston, MA; Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA., Harvard Medical School, Boston, MA; Department Medical Oncology, Dana-Farber Cancer Institute, Boston, MA., Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: .