Real-World Disease Management Costs for U.S. Patients With Muscle Invasive Bladder Cancer (MIBC) Following Radical Cystectomy (RC) in Contemporary Practice
Author(s)
Yizhen Lai, MS1, Daniel J. Hill-McManus, BSc, PhD2, Patrick Squires, PharmD, PhD1, Erin Cook, ScD3, Yan Song, PhD3, Ching-Yu Wang, BS, MS, PhD1, Shravanthi Seshasayee, MPH3, Ronac Mamtani, MD, MSCE4;
1Merck & Co., Inc., Rahway, NJ, USA, 2MSD (UK) Ltd, London, United Kingdom, 3Analysis Group, Boston, MA, USA, 4Hospitals of the University of Pennsylvania-Penn Presbyterian, Philadelphia, PA, USA
1Merck & Co., Inc., Rahway, NJ, USA, 2MSD (UK) Ltd, London, United Kingdom, 3Analysis Group, Boston, MA, USA, 4Hospitals of the University of Pennsylvania-Penn Presbyterian, Philadelphia, PA, USA
Presentation Documents
OBJECTIVES: Disease management costs (i.e., non-drug costs) constitute a significant portion of overall cost burden for MIBC patients. However, the pattern of these costs is not well understood. This study aims to assess disease management costs by disease state post-RC: disease free (DF), locoregional recurrence (LR), distant metastasis (DM), and death.
METHODS: The SEER-Medicare database (2007-2020) was used to identify patients with MIBC who received RC. Disease management costs per-patient-per-month (PPPM, in 2023 USD) were derived from all-cause healthcare costs excluding systemic drug costs. Costs incurred in DF state were summarized over time (months 1-3, month 4-year 2, and years 3+ since RC). Costs for LR and DM were estimated separately as one-time procedure costs and mean PPPM costs. DM costs were further broken into pre- and post-progression PPPM. Terminal care costs were estimated as those incurred within 30 days of death.
RESULTS: Costs were summarized among 1,122 patients in DF and 443 patients with recurrence (44 in LR, 413 in DM). Mean PPPM costs in DF were decreasing over time, with $7,916, $2,636, and $1,752 in months 1-3, month 4-year 2, years 3+. Compared to remaining DF, PPPM costs among patients who experienced any recurrence increased dramatically ($1,752 vs. $9,326). PPPM costs were $2,261 for LR, $5,630 for DM pre-progression overall ($12,483 in month 1), $8,101 for DM post-progression, and $20,578 for terminal care. Procedure costs were $4,554 and $5,707 for radiotherapy in LR and DM, and $21,482 for metastasectomy in DM.
CONCLUSIONS: For MIBC patients post-RC, disease management costs decrease as patients remain longer in the DF state. Recurrence, particularly metastatic recurrence, is associated with increased disease management costs. These results highlight the potential economic benefit of novel therapies which can maintain patients in the DF state or prevent recurrence in MIBC patients following RC.
METHODS: The SEER-Medicare database (2007-2020) was used to identify patients with MIBC who received RC. Disease management costs per-patient-per-month (PPPM, in 2023 USD) were derived from all-cause healthcare costs excluding systemic drug costs. Costs incurred in DF state were summarized over time (months 1-3, month 4-year 2, and years 3+ since RC). Costs for LR and DM were estimated separately as one-time procedure costs and mean PPPM costs. DM costs were further broken into pre- and post-progression PPPM. Terminal care costs were estimated as those incurred within 30 days of death.
RESULTS: Costs were summarized among 1,122 patients in DF and 443 patients with recurrence (44 in LR, 413 in DM). Mean PPPM costs in DF were decreasing over time, with $7,916, $2,636, and $1,752 in months 1-3, month 4-year 2, years 3+. Compared to remaining DF, PPPM costs among patients who experienced any recurrence increased dramatically ($1,752 vs. $9,326). PPPM costs were $2,261 for LR, $5,630 for DM pre-progression overall ($12,483 in month 1), $8,101 for DM post-progression, and $20,578 for terminal care. Procedure costs were $4,554 and $5,707 for radiotherapy in LR and DM, and $21,482 for metastasectomy in DM.
CONCLUSIONS: For MIBC patients post-RC, disease management costs decrease as patients remain longer in the DF state. Recurrence, particularly metastatic recurrence, is associated with increased disease management costs. These results highlight the potential economic benefit of novel therapies which can maintain patients in the DF state or prevent recurrence in MIBC patients following RC.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE315
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Oncology, SDC: Urinary/Kidney Disorders