OBJECTIVES : Patients with advanced urothelial carcinoma (UC) incur significant medical costs. This study describes healthcare resource use and costs incurred by patients with stage III or IV UC.

METHODS : This retrospective Surveillance, Epidemiology, and End Results-Medicare database analysis identified patients (≥66 years) with incident stage III or IV UC from 2004-2013. Patients were followed from UC diagnosis to death/last follow-up to estimate mean per-patient-per-month HCRU and costs for patients who: 1) had not received systemic chemotherapy (NC), 2) received (neo-)adjuvant chemotherapy without additional lines of therapy (N/Adj), or 3) received ≥1 line of therapy (LOT1+).

RESULTS : The sample included 1,612 stage III (63% NC, 12% N/Adj, 25% LOT1+; median follow-up: 17 months) and 2,327 stage IV (55% NC, 12% N/Adj, 33% LOT1+; median follow-up: 8 months). The NC group were older, sicker, and had shortest follow-up time in both stages. About 47% of stage III and 30% of stage IV patients had a cystectomy. More than half of patients had a UC-related hospitalization (55% stage III, 51% stage IV). Median length of stay ranged from 10 (NC, both stages) to 14 (N/Adj, Stage IV) days. LOT1+ patients had the lowest UC-related hospitalization PPPM costs (stage III: $800 LOT1+, $1,215 N/Adj, $2,494 NC; stage IV: $1,520 LOT1+, $1,604 N/Adj, $5,560 NC). The median number of UC-related office visits PPPM was highest in N/Adj and lowest in NC patients (0.73-1.22 stage III, 1.17-1.8 stage IV). UC-related office visit PPPM costs were lowest for LOT1+ patients in stage III ($749 LOT1+, $987 N/Adj, $854 NC) and N/Adj patients in stage IV ($1,224 LOT1+, $1,144 N/Adj, $1,815 NC).

CONCLUSIONS : Per-patient-per-month costs were highest for patients not receiving chemotherapy (sicker/shortest follow-up time) and lowest for patients receiving LOT1+. This study provides a benchmark for the relative cost burden associated with current UC treatment.