OBJECTIVES: Muscle-invasive bladder cancer (MIBC) and upper tract urothelial carcinoma (UTUC) represent MIUC. Standard of care in the absence of metastasis is radical surgery (RS), with neoadjuvant and adjuvant chemotherapy as potential additive treatment. No hospital related economic data on MIUC patients who have undergone RS in France was retrieved in the literature. Our purpose was to address this gap.

METHODS: Based on the French hospitalization database, MIUC adult patients who underwent a first RS (index stay) in 2015 were included. Patients were followed from index stay until December 31^st, 2020 or in-hospital death, whichever occurred first. Costs were associated to stays, expensive therapy, intensive care unit admission, emergency unit admission, or hospital specialist visits. These were described at index stay (total costs) and for each stage of the disease (disease free, local recurrence [LR], distant recurrence [DR]). Costs were calculated as per-patient-per-month from a payer perspective and adjusted to 2020 euros.

RESULTS: In 2015, 3,370 patients underwent RS. Median follow-up was 66 months with hospital death rate at 48.3%. For MIBC and UTUC patients, mean total (± standard deviation [sd]) costs of index stay were €13,184 (±9,522) and €8,254 (±4,507) per patient, respectively. Mean monthly overall costs (±sd) per patient were €3,313 (±6,642) for MIBC and €1,229 (±2,352) for UTUC. Mean monthly costs per patient without recurrence, with LR, and with DR, respectively, for MIBC patients were €1,567 (±4,113), €3,543 (±5,828), and €5,679 (±6,215); for UTUC patients, these were €549 (±1,485), €1,259(±2,767), and €3,801(±5,914). In all cases, most of the costs (>99%) were driven by hospital stays.

CONCLUSIONS: This study provides real-world evidence of economic burden on MIUC patients undergoing RS. Mean costs increased as the disease worsened and were higher for MIBC than for UTUC patients. Optimal patient management at an early stage may prevent costly recurrences.