OBJECTIVES: Intravesical Bacillus Calmette-Guerin (BCG) is the first line treatment for patients with high-risk NMIBC. There is a lack of contemporary data on its utilisation in routine clinical practice in Germany. This study aimed to describe the treatment patterns of adult patients treated with BCG as well as their health resource utilisation, cost burden and mortality rate.

METHODS: Bladder cancer patients (ICD-10: C67* or D09.0) who initiated BCG treatment between 01/01/2013 and 31/12/2016 (with no BCG record in 2008-2012) from a representative subset of the German statutory health insurance, Gesetzliche Krankenversicherung with 7% coverage of Germany, were followed up until 31/12/2017.

RESULTS: 837 patients (84% males) were identified. Their mean (SD) age was 71.7 (9.6) years and mean follow-up (FU) time from BCG initiation was 2.6 (1.2) years. Patients received a mean of 11.5 (0.6) BCG instillations during a mean of 10.7 (10.1) months. 32% of patients received transurethral resection of bladder tumour while having BCG therapy; 38% had the procedure after their last BCG.

After last BCG (mean FU: 1.4 years), 61% of patients did not receive any further treatment while the rest: 15% had a systemic antineoplastic agent and/or radiotherapy without cystectomy; 12% had a cystectomy and 11% received mitomycin. 17% of patients died (mean FU time from BCG initiation: 2.1 years). Total cost per patient-year (including hospitalizations, primary care, drugs dispensed and sick leaves) was €10,126.

CONCLUSIONS: About two-thirds of patients did not receive any further treatment after their last BCG instillation, indicating that they may not have had recurring or progressing disease during the FU available for this study. However, a longer FU time is needed to evaluate responsiveness to BCG, treatment patterns, including use of cystectomy which may be recommended for unresponsive patients, and other outcomes following recurrence or progression.