OBJECTIVES : This study assessed the use of and contribution of specific components of oncology care to overall costs for metastatic bladder cancer patients.

METHODS : This retrospective study used medical and pharmacy claims from a US database (2011-2017). Subjects were commercial (COM) and Medicare Advantage (MA) enrollees with metastatic bladder cancer. Index date was 1st claim for metastasis after bladder cancer diagnosis. Inclusion criteria were medical and pharmacy benefits (24 months pre- and ≥1 month post-index); anti-cancer systemic treatment after metastatic diagnosis. Measures were lines of therapy (1L, 2L, until end of treatment); and utilization and costs of anti-cancer systemic treatment, bladder surgery, radiation, monitoring, and supportive care. Use was assessed via Kaplan Meier (KM).

RESULTS : The study included 652 metastatic bladder patients (62% MA). Most frequent 1L regimens were cisplatin-gemcitabine (COM/MA) (29%/23%) and carboplatin-gemcitabine (12%/20%). KM estimates showed that by 1 year post-metastatic diagnosis, (COM/MA) 54%/43% had post-metastasis bladder-cancer-surgery, 37%/38% radiation treatment, 18%/19% intravesical therapy, 99%/100% monitoring, and 100% supportive care. By 3 years post-metastatic diagnosis, KM treatment rates were (COM/MA) 64%/60% with surgery and 58%/57% with radiation. During 1L, mean costs included (COM/MA) $12,304/$4,601 monitoring; $10,164/$6,198 supportive care; $8,301/$3,411 systemic therapy; $8,041/$3,250 radiation; $3,740/$1,143 surgery. Across the entire post-metastatic follow-up, the highest mean treatment costs (per-patient-per-month) were for surgery (COM) $ 4,782 (SD 9,338) and monitoring $4,563 (SD 8,811); MA was similar with a lower cost point. The ratio of chemotherapy to total costs across the entire post-metastatic follow-up was COM 0.07 (SD 0.14)/MA 0.07 (SD 0.15).

CONCLUSIONS : Among patients with metastatic bladder cancer, monitoring, radiation, and supportive care were high contributors of care during the period of systemic treatment. For accountable care organizations, a deeper understanding of the contributors to costs for oncology care for the most severely ill patients will allow for more informed program implementation.