Most elderly mUC pts receive platinum-based therapy as first line of treatment (LOT) but invariably progress, requiring additional LOT and HCRU. This analysis estimated medical costs and HCRU associated with each LOT in US elderly pts.
Pts ≥66 years of age newly diagnosed with mUC (urothelial transitional cell carcinoma) between 2004 and 2011 were identified from the SEER-Medicare database. Pts were followed from diagnosis to death, Medicare disenrollment, HMO enrollment, or till 31 December 2013 to characterize treatments by LOT (first [1L], second [2L], and third + [3L+] LOT). The per-pt HCRU was examined. Cumulative mean costs (overall and by type of LOT) were reported.
Among 1,873 eligible mUC pts (median age, 77 years; male, 63%; Charlson comorbidity index ≥2, 29%; median follow-up, 7.5 months), 1,035 (55%) pts did not receive any chemotherapy. Among the 838 chemotherapy-treated pts, 510 (61%), 204 (24%), and 124 (15%) received 1L, 2L, and 3L+ LOT, respectively. Compared with 2L, 3L+ pts had significantly higher mean (standard deviation) per-pt hospital admissions (4.1 [2.9] vs 4.8 [3.3]), computed tomography (CT) scans (7.4 [4.4] vs 9.9 [5.8]), positron emission tomography–CT scans (1.0 [1.5] vs 2.0 [2.9]), and bone scans (1.1 [1.1] vs 1.8 [2.3]). Pts who received 3L+ LOT had significantly higher cumulative mean costs than 2L pts, mostly attributed to physician and outpatient services where chemotherapy is administered (Table).Table:
1131P Cumulative per-patient costs from 3 months before diagnosis to end of follow-up (% total)
|Cost category||All patients (N = 1,873)||No chemotherapy (N = 1,035)||1L only (N = 510)||2L only (N = 204)||3L + (N = 124)||P-value (3L+ vs 2L)|
|Median follow-up time, months||7.5||3.8||11.8||16.1||26.5|
|Mean costs (%), $US||82,912 (100)||57,208 (100)||99,422 (100)||123,262 (100)||162,549 (100)|
For pts with mUC, cumulative mean costs increased with additional LOT, although further analysis of cumulative costs over the treatment duration of each LOT is warranted. As the treatment landscape evolves to include immunotherapy, this analysis provides a benchmark for the relative costs associated with mUC treatment across different traditional LOT in the United States.
Clinical trial identification
Legal entity responsible for the study
A. Aly: Reports grants from Bristol-Myers Squibb, during the conduct of the study; grants from Bristol-Myers Squibb, Celldex, Celgene, Daiichi Sankyo, Pharmacyclics, and Amgen, outside the submitted work. C. Johnson: Reports grants from Bristol-Myers Squibb, during the conduct of the study. S. Yang, S. Rao: Reports personal fees from Bristol-Myers Squibb, during the conduct of the study; personal fees from Bristol-Myers Squibb, outside the submitted work. M. Botteman: Reports grants from Bristol-Myers Squib, during the conduct of the study; grants from Bristol-Myers Squib, Celgene, Celldex, Shire, outside the submitted work; and is an employee and owner of Pharmerit International. A. Hussain: Served as a consultant for Bristol-Myers Squibb.