Contemporary Treatment Patterns of Patients with Muscle-Invasive Bladder Cancer Undergoing Radical Cystectomy: A Retrospective Analysis of German Claims Data
Author(s)
Jennifer Stuart, ScD1, Evi Zhuleku, MSc2, Antje Mevius, MA3, Patrick Squires, PharmD, PhD1, Mehmet Burcu, PhD1, Chethan Ramamurthy, MD1.
1Merck & Co., Inc., Rahway, NJ, USA, 2Cytel Inc., Berlin, Germany, 3Institut für Pharmakoökonomie und Arzneimittellogistik e.V., Wismar, Germany.
1Merck & Co., Inc., Rahway, NJ, USA, 2Cytel Inc., Berlin, Germany, 3Institut für Pharmakoökonomie und Arzneimittellogistik e.V., Wismar, Germany.
Presentation Documents
OBJECTIVES: Despite therapeutic advances in muscle-invasive bladder cancer (MIBC), patients experience high recurrence rates and overall poor prognosis. Adjuvant nivolumab received EMA approval in March 2022 for certain patients with high recurrence risk, but subsequent uptake is unknown. This study aimed to describe characteristics and contemporary, real-world treatment patterns of patients with MIBC receiving radical cystectomy (RC) in Germany.
METHODS: Adult patients (≥18y) with ≥1 inpatient or outpatient specialist diagnosis for bladder cancer (BC; ICD-10-GM: C67.-) from 01Jan2010-30June2023 and a subsequent RC procedure (OPS: 5-576.2 to 5-576.7) from 01Oct2021-30Jun2023 were identified from the German AOK PLUS claims dataset (>3.4 million individuals). As diagnostic codes for MIBC are unavailable, RC following BC diagnosis and exclusion of metastatic or in situ disease were used to proxy MIBC. Patients were eligible if they had no prior partial cystectomy, no metastasis/recurrence-related indicators (secondary malignant neoplasms or immunotherapies for metastatic disease) or bladder carcinoma or radiotherapy ≤6 months before RC, and were continuously insured for ≥6 months pre- and post-index (RC). Patient characteristics were described during baseline (six months pre-index/index) and treatment was evaluated in the neoadjuvant (NAT, six months pre-index) and adjuvant settings (AT, six months post-index to study end [31Dec2023] or occurrence of metastatic/recurrence-related event or death, if earlier).
RESULTS: The analysis included 319 MIBC patients (median follow-up: 14.3 months; mean age: 71.4±9.7y, 76.2% male; mean Charlson Comorbidity Index: 7.0±3.0). Surgery without NAT/AT was the most frequent treatment (75.9%). Overall, 40 patients (12.5%) received NAT, 40 (12.5%) received AT, and 3 (0.9%) received both. Among adjuvant-treated patients, 27 (67.5%) received chemotherapy, 12 (30.0%) nivolumab, and 7 (17.5%) radiotherapy. Of note, 3.8% of all RC-treated MIBC patients received adjuvant nivolumab.
CONCLUSIONS: Among contemporary German patients undergoing RC for MIBC, there was low neoadjuvant and adjuvant therapy use, including low adjuvant nivolumab uptake, suggesting underutilization of available systemic therapies.
METHODS: Adult patients (≥18y) with ≥1 inpatient or outpatient specialist diagnosis for bladder cancer (BC; ICD-10-GM: C67.-) from 01Jan2010-30June2023 and a subsequent RC procedure (OPS: 5-576.2 to 5-576.7) from 01Oct2021-30Jun2023 were identified from the German AOK PLUS claims dataset (>3.4 million individuals). As diagnostic codes for MIBC are unavailable, RC following BC diagnosis and exclusion of metastatic or in situ disease were used to proxy MIBC. Patients were eligible if they had no prior partial cystectomy, no metastasis/recurrence-related indicators (secondary malignant neoplasms or immunotherapies for metastatic disease) or bladder carcinoma or radiotherapy ≤6 months before RC, and were continuously insured for ≥6 months pre- and post-index (RC). Patient characteristics were described during baseline (six months pre-index/index) and treatment was evaluated in the neoadjuvant (NAT, six months pre-index) and adjuvant settings (AT, six months post-index to study end [31Dec2023] or occurrence of metastatic/recurrence-related event or death, if earlier).
RESULTS: The analysis included 319 MIBC patients (median follow-up: 14.3 months; mean age: 71.4±9.7y, 76.2% male; mean Charlson Comorbidity Index: 7.0±3.0). Surgery without NAT/AT was the most frequent treatment (75.9%). Overall, 40 patients (12.5%) received NAT, 40 (12.5%) received AT, and 3 (0.9%) received both. Among adjuvant-treated patients, 27 (67.5%) received chemotherapy, 12 (30.0%) nivolumab, and 7 (17.5%) radiotherapy. Of note, 3.8% of all RC-treated MIBC patients received adjuvant nivolumab.
CONCLUSIONS: Among contemporary German patients undergoing RC for MIBC, there was low neoadjuvant and adjuvant therapy use, including low adjuvant nivolumab uptake, suggesting underutilization of available systemic therapies.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EPH169
Topic
Epidemiology & Public Health
Disease
SDC: Oncology, SDC: Urinary/Kidney Disorders