Real-World Healthcare Resource Utilization (HCRU) and Economic Burden Among Patients With High-Risk Carcinoma-In-Situ (CIS) Non-Muscle Invasive Bladder Cancer (NMIBC) Using a Large Medicare Dataset
Author(s)
Stephen Williams, MD1, Arveen Kaur, PhD2, Jinghua He, PhD2, Wenxi Huang, MS2, Hiremagalur Balaji, MD2, Kruti Joshi, MS2, Lorie Ellis, PhD2, Mukul Singhal, PhD2;
1The University of Texas Medical Branch, Galveston, TX, USA, 2Johnson & Johnson, Horsham, PA, USA
1The University of Texas Medical Branch, Galveston, TX, USA, 2Johnson & Johnson, Horsham, PA, USA
Presentation Documents
OBJECTIVES: Bladder cancer (BC) is the sixth most common cancer in the US, with 75% diagnosed as non-muscle invasive (NMIBC). Carcinoma-in-situ (CIS) is a high-risk subtype of NMIBC associated with higher likelihood of progression. Intravesical Bacillus Calmette-Guérin (iBCG) and Intravesical Gemcitabine (iGEM) are the most commonly used treatments in these patients. However, there is a lack of evidence on the economic burden. This study assessed the healthcare cost and healthcare resource utilization (HCRU) in high-risk CIS NMIBC patients treated with iBCG or iGEM.
METHODS: This retrospective cohort study used the SEER-Medicare database to identify patients aged ≥65 years with high-risk CIS NMIBC diagnosed between 2008-2019 who received iBCG or iGEM as first intravesical treatment. All included patients had continuous Medicare Fee-for-Service (FFS) enrollment for ≥12 months prior to the index date (1st treatment date). All-cause and BC-related HCRU and costs were summarized as per-patient-per-year (PPPY) descriptively from the index date until the earliest of end of Medicare data availability (12/31/2020), Medicare Part A/B FFS disenrollment, or death.
RESULTS: A total of 1,688 patients (iBCG n=1,662; iGEM n=26) were included (mean age 77.0 years, 83.3% male, 94.9% White, mean NCI Comorbidity Index 0.71 (SD=0.66)). During a mean follow up of 4.6 years, the mean PPPY rates for emergency room visit, the hospital admission, physician office visit, and outpatient encounter were 1.0 (SD=2.6), 1.0 (SD=2.9), 14.2 (SD=9.8), and 8.4 (SD=9.3), respectively. The average all-cause healthcare cost was $33,046 (SD=$70,637) PPPY, whereas the average BC-related healthcare cost was $11,602 (SD=$44,220) PPPY. Inpatient costs accounted for nearly 50% of both all-cause (mean=$15,472, SD=$48,326) and BC-related costs (mean=$5,865, SD=$42,258).
CONCLUSIONS: Patients with high-risk CIS NMIBC treated with iBCG and iGEM experienced substantial all-cause and BC-related HCRU and economic burden. Newer treatment options that reduce healthcare utilization could provide significant benefits for both the health system and patients.
METHODS: This retrospective cohort study used the SEER-Medicare database to identify patients aged ≥65 years with high-risk CIS NMIBC diagnosed between 2008-2019 who received iBCG or iGEM as first intravesical treatment. All included patients had continuous Medicare Fee-for-Service (FFS) enrollment for ≥12 months prior to the index date (1st treatment date). All-cause and BC-related HCRU and costs were summarized as per-patient-per-year (PPPY) descriptively from the index date until the earliest of end of Medicare data availability (12/31/2020), Medicare Part A/B FFS disenrollment, or death.
RESULTS: A total of 1,688 patients (iBCG n=1,662; iGEM n=26) were included (mean age 77.0 years, 83.3% male, 94.9% White, mean NCI Comorbidity Index 0.71 (SD=0.66)). During a mean follow up of 4.6 years, the mean PPPY rates for emergency room visit, the hospital admission, physician office visit, and outpatient encounter were 1.0 (SD=2.6), 1.0 (SD=2.9), 14.2 (SD=9.8), and 8.4 (SD=9.3), respectively. The average all-cause healthcare cost was $33,046 (SD=$70,637) PPPY, whereas the average BC-related healthcare cost was $11,602 (SD=$44,220) PPPY. Inpatient costs accounted for nearly 50% of both all-cause (mean=$15,472, SD=$48,326) and BC-related costs (mean=$5,865, SD=$42,258).
CONCLUSIONS: Patients with high-risk CIS NMIBC treated with iBCG and iGEM experienced substantial all-cause and BC-related HCRU and economic burden. Newer treatment options that reduce healthcare utilization could provide significant benefits for both the health system and patients.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE390
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology