Treatment-Related Costs Among Patients With Metastatic Bladder Cancer


A recent study investigated the drug utilization, health care resource utilization, and disease-related costs among patients with metastatic bladder cancer, presented at the 2017 ESMO conference (September 8-12, 2017; Madrid, Spain).

The conventional standard of care for patients with metastatic bladder cancer is first-line cisplatin, followed by second-line taxane or other systemic chemotherapy. However, limited data exist regarding the longitudinal costs and resources utilized during the treatment of patients with such disease.

A group of international researchers led by Kyle Flannery, PharmD, Merck & Co (Kenilworth, NJ), conducted a study to analyze data involving drug utilization, health care resource use, and disease-related costs for patients with metastatic bladder cancer. The retrospective study sampled 1215 patients (aged ≥ 65 years) with an initial diagnosis between 2007 and 2011 from SEER-Medicare linked data. Patients were classified into any of three treatment groups based on the chemotherapy regimen they received in the first- and second-line setting.: cisplatin-based, carboplatin-based, or nonplatinum-based.

Annual survival rates were calculated, and total costs were estimated during the treatment exposure window for health care visits and treatment disease-related, adverse event-related, and other costs.

Among patients treated in the first-line setting, the 1-, 2-, and 3-year survival rates were 56.5%, 25.6%, and 15.5%, respectively, compared with 12.9%, 6.0%, and 4.7% for untreated patients. Patients treated in the second-line setting benefited from survival rates of 32.8%, 14.9%, and 7.7%, respectively.


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Researchers reported that the total costs of cancer during the first- and second-line treatment windows were $36,793 and $26,732, respectively, corresponding to $12,503 and $11,671 spent per-patient-per-month. Consequently, the patients were responsible for $5902 of total first-line treatment costs and $4267 for second-line costs.

Additionally, researchers noted that the highest per-patient costs occurred in the outpatient setting, followed by emergency, inpatient, skilled-nursing facility, and hospice settings. Disease-specific care accounted for more than 50% of the cost, with the remainder attributed to adverse events and other costs.

Authors of the study concluded that cancer-related outpatient and emergency health care utilization were the primary drivers of per-patient economic burden, which may be due to first-line chemotherapy guideline-adherence rates being lower than 50%. Total cost of care for metastatic bladder cancer should be weighed against the clinical outcomes likely to be achieved with any therapeutic option, they wrote.—Zachary Bessette