ECONOMIC BURDEN OF RECURRENCE AFTER TRIMODAL THERAPY FOR BLADDER CANCER
Author(s)
Ronac Mamtani, MD, MSCE1, Monika Raut, MS, PhD2, Hal Yapici, MBA, MPH, MD3, Weiqi Jiao, Sc.M.3, Frank Su, PhD3, Annabelle Davies, MSc4, Joyce Y. Lai, MS2, Haojie Li, PhD2, Nancy Davis, PhD2;
1University of Pennsylvania Perelman School of Medicine, Abramson Cancer Center, Perelman School of Medicine, Philadelphia, PA, USA, 2Merck & Co. Inc., Rahway, NJ, USA, 3Boston Strategic Partners, Inc., Boston, MA, USA, 4MSD, London, United Kingdom
1University of Pennsylvania Perelman School of Medicine, Abramson Cancer Center, Perelman School of Medicine, Philadelphia, PA, USA, 2Merck & Co. Inc., Rahway, NJ, USA, 3Boston Strategic Partners, Inc., Boston, MA, USA, 4MSD, London, United Kingdom
OBJECTIVES: Care after trimodal therapy (TMT) for muscle-invasive bladder cancer (MIBC) may involve substantial healthcare resource utilization (HCRU) and costs, particularly among patients who recur. We quantified the incremental economic burden associated with recurrence following TMT.
METHODS: SEER-Medicare data (01/01/2007-09/30/2020) were used to identify older adults (≥65 years) with MIBC (stage T2-T4a N0M0) treated with TMT, defined as maximal transurethral resection of bladder tumor followed by chemoradiotherapy within 6 months. Recurrence was defined by any of: (1) intravesical treatment, radical cystectomy, or diagnosis of non-bladder secondary malignancy post-TMT; (2) initiation of cancer treatments ≥120 days post-TMT; (3) diagnosis of locoregional recurrence, distant metastasis, or secondary bladder malignancy ≥60 days post-TMT. All-cause and bladder cancer (BC)-related HCRU and costs (adjusted to 2025) were calculated per-patient per-month (PPPM), overall and by setting (inpatient, outpatient, emergency room, other). Comparisons used Wald chi-square tests (significance level α=0.05).
RESULTS: Of 1,032 TMT-treated patients, 552 (53.5%) experienced recurrence (median time to recurrence: 2.5 years). Patients with recurrence had higher PPPM follow-up visits than those without, for all-cause (7.5 vs. 5.4 visits; p<0.0001) and BC-related care (2.5 vs. 1.4 visits; p<0.0001). This pattern was consistent across settings, including BC-related outpatient (1.2 vs. 0.6 PPPM visits) and inpatient care (1.1 vs. 0.7 visits). Recurrence was also associated with higher PPPM costs, including all-cause ($2,609 vs. $1,383, p<0.0001) and BC-related costs ($1,211 vs. $436, p<0.0001). For patients with recurrence, outpatient costs were highest, driving spending (all-cause outpatient: $1,398 vs. $517 PPPM; BC-related outpatient: $774 vs. $159 PPPM).
CONCLUSIONS: Recurrence following TMT in older adults with MIBC is associated with substantially higher HCRU and costs, largely driven by outpatient care. These findings highlight the need for, and economic value of, strategies that reduce recurrence risk and better coordinate survivorship care. The high visit burden also suggests meaningful patient time toxicity, warranting further study.
METHODS: SEER-Medicare data (01/01/2007-09/30/2020) were used to identify older adults (≥65 years) with MIBC (stage T2-T4a N0M0) treated with TMT, defined as maximal transurethral resection of bladder tumor followed by chemoradiotherapy within 6 months. Recurrence was defined by any of: (1) intravesical treatment, radical cystectomy, or diagnosis of non-bladder secondary malignancy post-TMT; (2) initiation of cancer treatments ≥120 days post-TMT; (3) diagnosis of locoregional recurrence, distant metastasis, or secondary bladder malignancy ≥60 days post-TMT. All-cause and bladder cancer (BC)-related HCRU and costs (adjusted to 2025) were calculated per-patient per-month (PPPM), overall and by setting (inpatient, outpatient, emergency room, other). Comparisons used Wald chi-square tests (significance level α=0.05).
RESULTS: Of 1,032 TMT-treated patients, 552 (53.5%) experienced recurrence (median time to recurrence: 2.5 years). Patients with recurrence had higher PPPM follow-up visits than those without, for all-cause (7.5 vs. 5.4 visits; p<0.0001) and BC-related care (2.5 vs. 1.4 visits; p<0.0001). This pattern was consistent across settings, including BC-related outpatient (1.2 vs. 0.6 PPPM visits) and inpatient care (1.1 vs. 0.7 visits). Recurrence was also associated with higher PPPM costs, including all-cause ($2,609 vs. $1,383, p<0.0001) and BC-related costs ($1,211 vs. $436, p<0.0001). For patients with recurrence, outpatient costs were highest, driving spending (all-cause outpatient: $1,398 vs. $517 PPPM; BC-related outpatient: $774 vs. $159 PPPM).
CONCLUSIONS: Recurrence following TMT in older adults with MIBC is associated with substantially higher HCRU and costs, largely driven by outpatient care. These findings highlight the need for, and economic value of, strategies that reduce recurrence risk and better coordinate survivorship care. The high visit burden also suggests meaningful patient time toxicity, warranting further study.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE58
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Oncology, SDC: Urinary/Kidney Disorders