OBJECTIVES: To describe treatment patterns and HRU in FFS beneficiaries with mUC.

METHODS: A retrospective cohort analysis was conducted using 100% CMS-sourced sample of Medicare FFS Parts A/B/D claims. Patients ≥18 years with ≥1 inpatient or ≥2 outpatient visits (≥7 days apart) with an ICD code for UC were identified between 1/1/15 and 6/30/18 (first UC visit = dID). Patients were required to have continuous FFS coverage for ≥6 months pre- and post-dID and evidence of metastatic disease post-dID. Patients with other cancers, those participating in clinical trials, or those with evidence of previous therapies during baseline were excluded. Patients receiving 1L treatment (first treatment date = tID) were categorized into 1) cisplatin based (cis), 2) carboplatin based (carbo), 3) nonplatinum chemotherapy based (nonplat), and 4) immuno-oncology (IO). Post-tID HRU was reported per 100 patients per month (P100PPM).

RESULTS: 18,769 patients met the selection criteria: 56.2% mUC patients received an identified 1L treatment, and 43.8% had no identified treatment. Among those receiving 1L, most patients received cis (43.4%) or carbo (21.7%), followed by nonplat (22.5%) and IO (12.3%). Treated patients had a mean age of 75.0 years; 28.5% were female, 90.5% were White, and 57.0% had CCI ≥4. Post-tID, the mean (SD) number of inpatient stays was highest among patients receiving carbo, at 14.8±17.1 stays P100PPM, compared with 13.7±16.4 (cis), 11.8±25.1 (IO), and 8.6±15.1 (nonplat). Mean (SD) number of outpatient visits was highest for patients receiving IO, at 195±136 visits P100PPM, followed by193±158 (carbo), 185±158 (cis), and 162±155 (nonplat).

CONCLUSIONS: 43.8% of Medicare FFS beneficiaries with mUC received no identified 1L treatment. Among those receiving 1L treatment, most patients received cis or carbo; however, HRU was similar across treated patients.