Healthcare Resource Utilization and Costs Among Bacillus Calmette-Guérin (BCG)-Experienced or Unresponsive Patients With Papillary-Only High-Risk Non–Muscle Invasive Bladder Cancer
Author(s)
Ali Raza Khaki, MD1, Mukul Singhal, PhD2, Carmine Rossi, PhD3, Bruno Emond, MSc3, Steven Liu, MSc4, Priscilla Jiang, MPH4, Rebecca Bungay, MSPH5, Dominic Pilon, MSc3, Kruti Joshi, MPH2, Michael Fabrizio, MD6.
1Stanford University School of Medicine, Palo Alto, CA, USA, 2Johnson & Johnson, Horsham, PA, USA, 3Analysis Group, Inc., Montreal, QC, Canada, 4Analysis Group, Inc., Boston, MA, USA, 5Analysis Group, Toronto, ON, Canada, 6Urology of Virginia, Virginia Beach, VA, USA.
1Stanford University School of Medicine, Palo Alto, CA, USA, 2Johnson & Johnson, Horsham, PA, USA, 3Analysis Group, Inc., Montreal, QC, Canada, 4Analysis Group, Inc., Boston, MA, USA, 5Analysis Group, Toronto, ON, Canada, 6Urology of Virginia, Virginia Beach, VA, USA.
OBJECTIVES: Characterize healthcare resource utilization (HRU) and costs among Bacillus Calmette-Guérin (BCG)-experienced or unresponsive patients with papillary-only high-risk non-muscle-invasive bladder cancer (HR-NMIBC) following recurrence or BCG unresponsiveness in a United States Medicare population.
METHODS: A retrospective cohort study using SEER-Medicare data (01/01/2007-12/31/2020) was conducted among patients aged ≥65 years with Fee-For-Service Medicare coverage (Parts A, B, D) diagnosed with papillary-only HR-NMIBC (T1 or high-grade Ta, without carcinoma in situ) who received adequate BCG induction (≥5 instillations within 70 days). Patients who experienced recurrence or BCG unresponsiveness (i.e., transurethral resection of bladder tumor, BCG re-challenge, biopsy, intravesical/systemic chemotherapy, radiotherapy, radical cystectomy, or pembrolizumab) and initiated subsequent treatment within 30 days were included. Per-patient-per-year (PPPY) all-cause and bladder cancer (BC)-related HRU and costs (2025 US dollars) were measured from the next treatment after recurrence or unresponsiveness until the earliest of 12 months of follow-up, enrollment plan switch, death, or end of continuous enrollment/data availability.
RESULTS: Overall, 96 BCG-experienced or unresponsive patients with papillary-only HR-NMIBC treated after recurrence or unresponsiveness (median age 76 years, 84% male, median follow-up 12 months) were analyzed. Patients had a mean number of days with all-cause outpatient services of 51.4 PPPY (BC-related: 28.3), 1.3 inpatient admissions PPPY (BC-related: 1.2), 10.0 inpatient days PPPY (BC-related: 8.3), and 1.0 emergency room (ER) visits PPPY (BC-related: 0.4). Patients incurred mean total all-cause healthcare costs PPPY of $90,336, including $25,836 in outpatient costs, $55,812 in inpatient costs, and $8,688 in other medical and pharmacy costs. Most costs were BC-related; total BC-related healthcare costs PPPY were $63,084, including $13,560 in outpatient costs, $46,152 in inpatient costs, and $3,372 in other medical and pharmacy costs.
CONCLUSIONS: BCG-experienced or unresponsive patients with papillary-only HR-NMIBC incurred substantial HRU and costs, with a large proportion being BC-related, highlighting the need for more effective bladder-sparing therapies with durable response after BCG.
METHODS: A retrospective cohort study using SEER-Medicare data (01/01/2007-12/31/2020) was conducted among patients aged ≥65 years with Fee-For-Service Medicare coverage (Parts A, B, D) diagnosed with papillary-only HR-NMIBC (T1 or high-grade Ta, without carcinoma in situ) who received adequate BCG induction (≥5 instillations within 70 days). Patients who experienced recurrence or BCG unresponsiveness (i.e., transurethral resection of bladder tumor, BCG re-challenge, biopsy, intravesical/systemic chemotherapy, radiotherapy, radical cystectomy, or pembrolizumab) and initiated subsequent treatment within 30 days were included. Per-patient-per-year (PPPY) all-cause and bladder cancer (BC)-related HRU and costs (2025 US dollars) were measured from the next treatment after recurrence or unresponsiveness until the earliest of 12 months of follow-up, enrollment plan switch, death, or end of continuous enrollment/data availability.
RESULTS: Overall, 96 BCG-experienced or unresponsive patients with papillary-only HR-NMIBC treated after recurrence or unresponsiveness (median age 76 years, 84% male, median follow-up 12 months) were analyzed. Patients had a mean number of days with all-cause outpatient services of 51.4 PPPY (BC-related: 28.3), 1.3 inpatient admissions PPPY (BC-related: 1.2), 10.0 inpatient days PPPY (BC-related: 8.3), and 1.0 emergency room (ER) visits PPPY (BC-related: 0.4). Patients incurred mean total all-cause healthcare costs PPPY of $90,336, including $25,836 in outpatient costs, $55,812 in inpatient costs, and $8,688 in other medical and pharmacy costs. Most costs were BC-related; total BC-related healthcare costs PPPY were $63,084, including $13,560 in outpatient costs, $46,152 in inpatient costs, and $3,372 in other medical and pharmacy costs.
CONCLUSIONS: BCG-experienced or unresponsive patients with papillary-only HR-NMIBC incurred substantial HRU and costs, with a large proportion being BC-related, highlighting the need for more effective bladder-sparing therapies with durable response after BCG.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE511
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Oncology