Abstract 3319
Background
First-line (1L) cisplatin, followed by second-line (2L) taxane or other systemic chemotherapy, has been the historic standard of care in metastatic bladder cancer (mBC). Little is known regarding longitudinal costs and resources consumed during treatment of mBC patient (pts). This study investigated drug utilization, health care (HC) resource use, and disease-related costs among pts with mBC.
Methods
Pts with an initial diagnosis of mBC between Jan 2007 - Dec 2011 were retrospectively identified using SEER-Medicare linked data. Annual survival rates were calculated for treated and untreated pts. Total costs were estimated during the treatment exposure window for HC visits and treatment for mBC-related, AE-related, and other costs; all costs were converted to 2016 US dollars.
Results
Overall, 411 eligible pts received 1L therapy and 189 (46.0%) subsequently received 2L therapy. For all 1L treated pts, the 1, 2, and 3-year survival rates from mBC diagnosis were 56.5%, 25.6%, and 15.5%, compared to 12.9%, 6.0%, and 4.7% for untreated pts (n = 804). For 2L pts, the 1, 2, and 3-year survival rates from 2L treatment initiation were 32.8%, 14.9%, and 7.7%. For all regimens, the highest per-patient cost occurred in the outpatient setting, followed closely by emergency, then inpatient, SNF, and lastly by hospice.Table:
1129P Costs Incurred During the Treatment Exposure Window for 1L and 2L mBC Therapies
| Outcome | Treatment Group | |||||||
|---|---|---|---|---|---|---|---|---|
| Overall | Cisplatin-based regimen | Carboplatin-based regimen | Non-platinum-based regimen | |||||
| 1L | 2L | 1L | 2L | 1L | 2L | 1L | 2L | |
| Sample size, n (%) | 411 (100%) | 189 (100%) | 162 (39.4%) | 22 (11.6%) | 185 (45.0%) | 71 (37.6%) | 64 (15.6%) | 95 (50.8%) |
| Total cost per patient, mean (SD) | $36,793 ($28,754) | $26,732 ($21,143) | $35,570 ($25,770) | $25,267 ($16,494) | $38,751 ($29,864) | $30,279 ($23,298) | $34,228 ($32,509) | $24,443 ($20,233) |
| mBC-related cost per patient, mean (SD) | $18,246 ($16,655) | $12,939 ($13,340) | $19,316 ($16,660) | $13,529 ($11,872) | $18,769 ($16,667) | $14,980 ($16,837) | $14,028 ($16,213) | $11,294 ($10,304) |
| AE-related cost per patient, mean (SD) | $7,629 ($12,399) | $4,988 ($9,471) | $6,240 ($10,814) | $4,170 (6,473) | $8,503 ($11,931) | $5,374 ($7,345) | $8,618 ($16,663) | $4,889 ($11,324) |
| Other costs per patient, mean (SD) | $12,990 ($16,906) | $10,363 ($14,753) | $11,900 ($15,817) | $7,992 ($6,823) | $13,708 ($17,587) | $11,468 ($16,895) | $13,673 ($17,670) | $10,090 ($14,416) |
Conclusions
In general, mBC pts had poor survival outcomes, particularly for untreated pts. Less than half of mBC pts received guideline-endorsed 1L cis-combo therapy. mBC-related outpatient and emergency HC utilization were primary drivers of the per-patient economic burden. During the treatment exposure window, total costs were considerable across treatment regimens, with the average total cost during 1L and 2L treatment exceeding sixty thousand dollars per patient.
Clinical trial identification
Legal entity responsible for the study
Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA provided funding for this study, yet the authors take full responsibility for the work as a whole, including the study design, access to data reported in the manuscript, and the decision to submit and publish the manuscript. All authors approved the final manuscript to be published.
Funding
Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA
Disclosure
K. Flannery, X. Cao, J. He, Y. Zhong: Employee of Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA. A. Kamat: Research funding: FKD Industries; Photocure; Merck; and Heat Biologics. Consulting or advisory role: Cepheid; Photocure; Telesta Therapeutics; Sanofi; Merck; Abbott Molecular; Theralase; Heat Biologics; Spectrum Pharmaceuticals; and Oncogenix. All other authors have declared no conflicts of interest.