Economic Burden of Recurrence among Patients with High-Risk Non-Muscle-Invasive Bladder Cancer who Received Bacillus Calmette-Guérin in the United States: A SEER-Medicare Study
Author(s)
Rituparna Bhattacharya, PhD1, Honghao Fang, MS2, Yizhen Lai, MS1, Shujing Zhang, PhD1, Jiayang Li, PhD3, Pangsibo Shen, MS3, Wei Gao, PhD3, Yan Song, PhD3, Hema Dave, PhD1, Haojie Li, PhD4, Yair Lotan, MD5.
1Merck & Co., Inc., Rahway, NJ, USA, 2Analysis Group, Inc., Montreal, QC, Canada, 3Analysis Group, Inc., Boston, MA, USA, 4Merck & Co, Rahway, NJ, USA, 5University of Texas Southwestern Medical Center, Dallas, TX, USA.
1Merck & Co., Inc., Rahway, NJ, USA, 2Analysis Group, Inc., Montreal, QC, Canada, 3Analysis Group, Inc., Boston, MA, USA, 4Merck & Co, Rahway, NJ, USA, 5University of Texas Southwestern Medical Center, Dallas, TX, USA.
OBJECTIVES: This study assessed the impact of recurrence on healthcare resource utilization (HCRU) and costs in patients with high-risk non-muscle-invasive bladder cancer (HR-NMIBC) who received Bacillus Calmette-Guérin (BCG).
METHODS: A retrospective cohort study was conducted using SEER-Medicare data (2007-2020). Patients with HR-NMIBC (TisN0M0, T1N0M0, or high-grade TaN0M0) who received BCG were stratified into recurrence (i.e., patients with NMIBC recurrence, muscle-invasive bladder cancer progression, or distant metastasis) and non-recurrence cohorts. In the recurrence cohort, the index date was defined as 30 days before the first recurrence to capture recurrence-related HCRU before recurrence; in the non-recurrence cohort, the index date was randomly assigned to match the time from BCG initiation to recurrence in the recurrence cohort. Post-index all-cause HCRU, including inpatient (IP) admissions, outpatient (OP) visits, emergency department (ED) visits and skilled nursing facility (SNF) visits, and associated costs (2023 USD) were summarized on a per-patient-per-month (PPPM) basis and compared between cohorts using a generalized linear regression model.
RESULTS: The study included 2,164 and 2,586 patients in recurrence and non-recurrence cohorts, respectively (median follow-up: 23.82 and 26.23 months). Significantly higher proportions of patients incurred ≥1 all-cause HCRU in recurrence vs. non-recurrence cohorts (IP: 66.2% vs. 47.9%, OP: 99.6% vs. 97.1%, ED: 54.6% vs. 45.2%, SNF: 20.7% vs. 18.0%; all p<0.05). Among patients who incurred HCRU, mean numbers of OP and ED visits PPPM were significantly higher in the recurrence cohort (OP: 2.93 vs. 1.88, ED: 0.17 vs. 0.12; both p<0.05). All-cause PPPM healthcare costs were also higher in the recurrence cohort (total: $5,058 vs. $2,207; IP: $2,472 vs. $980; OP: $1,548 vs. $504; ED: $80 vs. $41, SNF: $270 vs. $177; others: $687 vs. $505; all p<0.05).
CONCLUSIONS: Recurrence following BCG was associated with significantly higher HCRU and costs, highlighting the need for more effective therapies that may potentially reduce economic burden.
METHODS: A retrospective cohort study was conducted using SEER-Medicare data (2007-2020). Patients with HR-NMIBC (TisN0M0, T1N0M0, or high-grade TaN0M0) who received BCG were stratified into recurrence (i.e., patients with NMIBC recurrence, muscle-invasive bladder cancer progression, or distant metastasis) and non-recurrence cohorts. In the recurrence cohort, the index date was defined as 30 days before the first recurrence to capture recurrence-related HCRU before recurrence; in the non-recurrence cohort, the index date was randomly assigned to match the time from BCG initiation to recurrence in the recurrence cohort. Post-index all-cause HCRU, including inpatient (IP) admissions, outpatient (OP) visits, emergency department (ED) visits and skilled nursing facility (SNF) visits, and associated costs (2023 USD) were summarized on a per-patient-per-month (PPPM) basis and compared between cohorts using a generalized linear regression model.
RESULTS: The study included 2,164 and 2,586 patients in recurrence and non-recurrence cohorts, respectively (median follow-up: 23.82 and 26.23 months). Significantly higher proportions of patients incurred ≥1 all-cause HCRU in recurrence vs. non-recurrence cohorts (IP: 66.2% vs. 47.9%, OP: 99.6% vs. 97.1%, ED: 54.6% vs. 45.2%, SNF: 20.7% vs. 18.0%; all p<0.05). Among patients who incurred HCRU, mean numbers of OP and ED visits PPPM were significantly higher in the recurrence cohort (OP: 2.93 vs. 1.88, ED: 0.17 vs. 0.12; both p<0.05). All-cause PPPM healthcare costs were also higher in the recurrence cohort (total: $5,058 vs. $2,207; IP: $2,472 vs. $980; OP: $1,548 vs. $504; ED: $80 vs. $41, SNF: $270 vs. $177; others: $687 vs. $505; all p<0.05).
CONCLUSIONS: Recurrence following BCG was associated with significantly higher HCRU and costs, highlighting the need for more effective therapies that may potentially reduce economic burden.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
P1
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology