OBJECTIVES: To estimate Health Care Resource Utilization (HCRU) and costs for patients with Intermediate- to High-Risk Non-Muscle Invasive Bladder Cancer (NMIBC) who received adequate vs inadequate BCG maintenance therapy among Medicare beneficiaries.

METHODS: HCRU and treatment utilization was based on select medical and pharmacy encounters from the index date (BCG initiation) through the end of the variable follow-up period using Medicare claims data from 2010-2019. Subgroup 1: Adequate BCG Maintenance Therapy -- patients who received ≥7 instillations of BCG within 274 days of index date. Subgroup 2: Inadequate BCG Maintenance Therapy -- patients that did not qualify for subgroup 1. NMIBC-related hospitalizations and emergency room (ER) visits included encounters with a diagnosis code for bladder cancer in the first or second position on claim. The specific evaluations of HCRU and treatment utilization included hospital stays and visits.

RESULTS: 12,109 patients of a total 19,850 in subgroup 1 (61%) had ≥1 all-cause hospitalizations vs. 17,209 of a total 26,193 in subgroup 2 (66%). There were ~9,727 all-cause hospitalizations/year for subgroup 1 vs. ~15,892 for subgroup 2. The total number of all-cause hospitalization bed days/year was ~52,768 for subgroup 1 vs. ~87,749 for subgroup 2. 14,984 patients (75%) in subgroup 1 had ≥1 all-cause ER visits vs. 20,529 patients (78%) in subgroup 2. The total number of ER visits/year was ~27,290 for subgroup 1 vs. ~43,790 for subgroup 2. The total medical and pharmacy costs/year were $571,072,516 for subgroup 1 vs. $845,903,312 for subgroup 2. The mean total medical and pharmacy costs/patient/year were $28,756 for subgroup 1 vs. $32,295 for subgroup 2.

CONCLUSIONS: HCRU and costs associated with NMIBC patient hospital stays, procedures and ER visits place a substantial burden on healthcare systems. Adequate BCG maintenance therapy may be associated with lower HCRU compared with inadequate BCG maintenance therapy.