DEVELOPMENT OF AN ALGORITHM ESTIMATING CISPLATIN-BASED CHEMOTHERAPY INELIGIBILITY AMONG PATIENTS WITH MUSCLE-INVASIVE BLADDER CANCER USING REAL-WORLD DATA
Author(s)
Manami Bhattacharya, PhD, MS1, Yong Zhu, PhD2, Nicole M. Engel-Nitz, MS, PhD2, Lisa Le, MS2, Stephanie Gallagher, MPH2, Aaron Springford, PhD3, Raj Satkunasivam, MD, MS4;
1AstraZeneca, Gaithersburg, MD, USA, 2Optum, Eden Prairie, MN, USA, 3AstraZeneca, Mississauga, ON, Canada, 4Houston Methodist Urology Associates, Houston, TX, USA
1AstraZeneca, Gaithersburg, MD, USA, 2Optum, Eden Prairie, MN, USA, 3AstraZeneca, Mississauga, ON, Canada, 4Houston Methodist Urology Associates, Houston, TX, USA
OBJECTIVES: Muscle-invasive bladder cancer (MIBC) represents ~25% of bladder cancer cases in the United States. Guidelines recommend treatment based on cisplatin-based chemotherapy eligibility. Cisplatin eligibility and ineligibility is determined using the Galsky criteria—assessments that typically require clinical data. We developed a claims-based algorithm using real-world data as proxies for Galsky criteria to identify cisplatin ineligibility among patients with MIBC to assist researchers and payors interested in real-world use of cisplatin-based therapies.
METHODS: Patients diagnosed with MIBC between July 2016-September 2023 were identified from Optum’s Market Clarity Database. The proxy algorithm incorporated diagnosis and procedure codes representing key Galsky criteria: ECOG performance score ≥2, acute kidney injury/stage 2-5 chronic kidney disease as a proxy for creatinine clearance, hearing loss/hearing aid use, peripheral neuropathy, and heart failure. Patients meeting 1 or more criteria were classified as cisplatin-ineligible. Patient characteristics were compared by cisplatin eligibility using chi-square tests, with overall survival (OS) analyzed using Kaplan-Meier methods and log-rank tests.
RESULTS: Among 2,210 patients with MIBC, 53.6% were classified as cisplatin-ineligible by the proxy algorithm. Cisplatin-ineligible patients were older (73.5±9.9 vs. 66.8±10.9 years, p<0.001), had higher baseline Charlson comorbidity scores (2.1±1.8 vs. 1.0±1.3, p<0.001), and shorter median OS (median=57 months versus not reached, p<0.001) compared to cisplatin-eligible patients.
CONCLUSIONS: We present a claims-based algorithm to estimate cisplatin ineligibility, a key treatment factor for MIBC. We demonstrate concordance with published clinical estimates of ~50% ineligibility and expected patient demographic and survival trends, showing this algorithm has potential to accurately identify cisplatin ineligibility among MIBC patients. Given the changing treatment landscape for MIBC, such algorithms are important tools for health services research, real-world evidence, and payers without access to clinical data to identify eligible patients and track real-world outcomes.
METHODS: Patients diagnosed with MIBC between July 2016-September 2023 were identified from Optum’s Market Clarity Database. The proxy algorithm incorporated diagnosis and procedure codes representing key Galsky criteria: ECOG performance score ≥2, acute kidney injury/stage 2-5 chronic kidney disease as a proxy for creatinine clearance, hearing loss/hearing aid use, peripheral neuropathy, and heart failure. Patients meeting 1 or more criteria were classified as cisplatin-ineligible. Patient characteristics were compared by cisplatin eligibility using chi-square tests, with overall survival (OS) analyzed using Kaplan-Meier methods and log-rank tests.
RESULTS: Among 2,210 patients with MIBC, 53.6% were classified as cisplatin-ineligible by the proxy algorithm. Cisplatin-ineligible patients were older (73.5±9.9 vs. 66.8±10.9 years, p<0.001), had higher baseline Charlson comorbidity scores (2.1±1.8 vs. 1.0±1.3, p<0.001), and shorter median OS (median=57 months versus not reached, p<0.001) compared to cisplatin-eligible patients.
CONCLUSIONS: We present a claims-based algorithm to estimate cisplatin ineligibility, a key treatment factor for MIBC. We demonstrate concordance with published clinical estimates of ~50% ineligibility and expected patient demographic and survival trends, showing this algorithm has potential to accurately identify cisplatin ineligibility among MIBC patients. Given the changing treatment landscape for MIBC, such algorithms are important tools for health services research, real-world evidence, and payers without access to clinical data to identify eligible patients and track real-world outcomes.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
RWD157
Topic
Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Oncology