Medicare patients with metastatic or surgically unresectable urothelial carcinoma (mUC) often receive platinum-based chemotherapy as first line of therapy (LOT) but invariably progress, requiring additional LOTs and healthcare resource use (HCRU). To better understand the evolving mUC treatment landscape, we estimated the economic burden of chemotherapy-based mUC treatments among US Medicare patients.
Newly diagnosed Medicare patients with mUC were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Patients were followed from diagnosis to death, disenrollment, or end of study to characterize LOTs (first [LOT1], second [LOT2], and third+ [LOT3+]). Kaplan-Meier methods were used to estimate overall survival (OS) by LOT. HCRU and mean costs were reported over the follow-up period, LOT duration, or maximum LOT received.
Among 1873 eligible patients with mUC (median age, 77 years; median follow-up, 7.5 months), 1035 (55%) received no chemotherapy. Among chemotherapy-treated patients, 61% had LOT1 only, 25% had LOT1 and LOT2 only, and 14% had ?3 LOTs. Median OS was 8.1 months, range 4.3 (untreated) to 29.8 (LOT3+) months. HCRU frequency increased with additional LOTs. Mean cumulative per-patient cost was $82,912 for all patients, increasing with additional LOTs (untreated, $57,207; LOT1, $99,213; LOT2, $125,190; LOT3+, $163,884). Mean per-patient, per-month cost was $18,827 for all patients, decreasing with increasing number of LOTs received (untreated, $27,211; LOT1, $9601; LOT2, $7325; LOT3+, $6017).
Potential for treatment misclassification when using the algorithm defining LOTs and non-generalizability of results to younger patients.
Over 50% of Medicare patients with mUC received no chemotherapy. Among chemotherapy-treated patients, most received only one LOT. Additional LOTs led to higher mean costs and HCRU, but as patients were followed longer, monthly costs decreased. As treatments evolve to include immuno-oncology agents, these findings provide a clinically-relevant economic benchmark for mUC treatment across different traditional LOTs.