Healthcare Resource Utilization (HCRU) and Related Direct Healthcare Costs for Patients with Metastatic Urothelial Cancer (mUC): Findings from a Retrospective Observational Cohort Study in a Clinical Practice Setting in Italy

OBJECTIVES: This study describes HCRU and direct healthcare costs of patients with mUC who received systemic chemotherapy and/or radiotherapy (or not) in the inpatient setting in Italy.

METHODS: This retrospective observational analysis used hospital discharge data (Scheda di Dimissione Ospedaliera) and regional data from LHU-Umbria-2 (in- and outpatient settings) to determine incident adult (age ≥18 years) patients with a first hospitalization for mUC (index) between 2017 and 2018, identified by a combination of International Classification of Diseases (ICD-9-CM), medical procedure, and diagnosis-related group codes. Results were analyzed descriptively, and healthcare costs were projected at a national level.

RESULTS: A total of 3,674 patients with mUC were identified, of whom 27.6% were treated with inpatient chemotherapy and/or radiotherapy, and 72.4% were not treated with either. A total of 1,715 (46.7%) had ≥1 all-cause rehospitalization (post index): 79.4% in treated and 34.2% in untreated patients. Mean (SD) number of rehospitalizations was 2.5(2.6) in treated and 0.6(1.2) in untreated patients. Mean (SD) cumulative length of stay was 14.7(18.5) and 5.6(12.6) days in the treated and untreated groups. Mean (SD) costs per patient of index hospital admission were €4,020(€3,118) in treated and €4,588(€3,322) in untreated patients. Monthly mean (SD) cumulative inpatient costs for treated patients peaked at €5,004(€3,593) during the first month (covering index hospitalization), which more than doubled after 36 months of follow-up (€11,734[€8,788]). Estimated national projected costs during the 36-month follow-up from first hospitalization for mUC were €34.3 million (95% CI, €30.3-€60.0 million) and €31.8 million (95% CI, €28.1-€56.0 million) when estimated after 1 year of follow-up.

CONCLUSIONS: The findings from this real-world study indicate a large economic burden of mUC in Italy despite a high rate of non-treatment. It highlights the need to better identify the reasons for not administering inpatient systemic chemotherapy and/or radiotherapy and to effectively use available therapies to alleviate care disparities.