REAL-WORLD ECONOMIC BURDEN AND HEALTHCARE RESOURCE UTILIZATION AMONG DE NOVO MUSCLE-INVASIVE BLADDER CANCER (DNMIBC) PATIENTS IN ONTARIO, CANADA
Author(s)
Shalak Gunjal, MS RPh1, Nikkita Dutta, MSc1, Steven D. Moore, BSc, PhD1, Daphne Hui, MSc1, Lidija Latifovic, BSc, MSc2, Ryan Ng, PhD3, Maria Esther Perez Trejo, PhD3, Nimira Alimohamed, MD4, Christopher J. Wallis, MD, PhD5;
1AstraZeneca Canada, Mississauga, ON, Canada, 2IQVIA Solutions Canada Inc., Mississauga, ON, Canada, 3IQVIA Solutions Canada Inc., Kirkland, QC, Canada, 4Arthur J.E. Child Comprehensive Cancer Centre, Calgary, AB, Canada, 5University Health Network, Toronto, ON, Canada
1AstraZeneca Canada, Mississauga, ON, Canada, 2IQVIA Solutions Canada Inc., Mississauga, ON, Canada, 3IQVIA Solutions Canada Inc., Kirkland, QC, Canada, 4Arthur J.E. Child Comprehensive Cancer Centre, Calgary, AB, Canada, 5University Health Network, Toronto, ON, Canada
OBJECTIVES: MIBC accounts for 20-25% of new bladder cancer diagnoses and carries substantial clinical and economic burden. Contemporary Canadian real-world evidence on healthcare resource utilization (HCRU) and costs is limited. This study evaluated the economic burden associated with de novo MIBC (dnMIBC) in Ontario - Canada's most populous province.
METHODS: This retrospective cohort study identified adult patients with dnMIBC, defined by receiving cystectomy, trimodal therapy (radical transurethral resection of bladder tumor followed by external beam radiation concurrently with radiosensitizing systemic therapy or chemoradiation), and/or radical radiotherapy, using ICES databases (January 2013-August 2024). HCRU and direct healthcare costs including physician visits, hospitalizations, emergency department (ED) visits, cancer clinics, and drugs were assessed across three 1-year phases: post-diagnosis, post-progression, and terminal with stratification by baseline estimated glomerular filtration rate (eGFR): (≤40mL/min, >40 to <60mL/min, and ≥60mL/min.
RESULTS: Among 2,735 patients with dnMIBC (75% male, mean age 70 years, mean follow-up 3.6 years), 27% progressed to metastasis and 55% died during the study. Attending physicians varied by phase (urologist in post-diagnosis, oncologist in post-progression, and general practitioner in terminally). Mean hospitalizations and ED visits were highest in terminal phase (2.5 and 3.8 visits, respectively). Mean post-diagnosis costs were $83,100 (standard deviation (SD) = $47,377, dominant contributor: hospitalizations=45%) per patient (pp) and $90,897 per patient year (ppy); post-progression costs were $70,993 (SD=$54,506, dominant contributor: cancer clinic=34%) pp and $97,146 ppy; and terminal costs were $92,150 (SD=$59,962, dominant contributor: hospitalizations=47%) pp and $109,308 ppy. PPY costs were highest in eGFR ≤40mL/min patients across all phases (post-diagnosis: $120,090; post-progression: $127,870; terminal: $124,290) compared with eGFR >40 to <60mL/min and ≥60mL/min patients.
CONCLUSIONS: These real-world data highlight the significant healthcare system impact of dnMIBC. Among patients with dnMIBC, economic burden increased with disease progression, was greatest at the end of life, and lowest in patients with eGFR ≥60mL/min.
METHODS: This retrospective cohort study identified adult patients with dnMIBC, defined by receiving cystectomy, trimodal therapy (radical transurethral resection of bladder tumor followed by external beam radiation concurrently with radiosensitizing systemic therapy or chemoradiation), and/or radical radiotherapy, using ICES databases (January 2013-August 2024). HCRU and direct healthcare costs including physician visits, hospitalizations, emergency department (ED) visits, cancer clinics, and drugs were assessed across three 1-year phases: post-diagnosis, post-progression, and terminal with stratification by baseline estimated glomerular filtration rate (eGFR): (≤40mL/min, >40 to <60mL/min, and ≥60mL/min.
RESULTS: Among 2,735 patients with dnMIBC (75% male, mean age 70 years, mean follow-up 3.6 years), 27% progressed to metastasis and 55% died during the study. Attending physicians varied by phase (urologist in post-diagnosis, oncologist in post-progression, and general practitioner in terminally). Mean hospitalizations and ED visits were highest in terminal phase (2.5 and 3.8 visits, respectively). Mean post-diagnosis costs were $83,100 (standard deviation (SD) = $47,377, dominant contributor: hospitalizations=45%) per patient (pp) and $90,897 per patient year (ppy); post-progression costs were $70,993 (SD=$54,506, dominant contributor: cancer clinic=34%) pp and $97,146 ppy; and terminal costs were $92,150 (SD=$59,962, dominant contributor: hospitalizations=47%) pp and $109,308 ppy. PPY costs were highest in eGFR ≤40mL/min patients across all phases (post-diagnosis: $120,090; post-progression: $127,870; terminal: $124,290) compared with eGFR >40 to <60mL/min and ≥60mL/min patients.
CONCLUSIONS: These real-world data highlight the significant healthcare system impact of dnMIBC. Among patients with dnMIBC, economic burden increased with disease progression, was greatest at the end of life, and lowest in patients with eGFR ≥60mL/min.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE480
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Oncology, SDC: Urinary/Kidney Disorders