OBJECTIVES: Recent drug approvals have changed the treatment landscape for mUC; however, real-world data on HCRU and costs are limited. Here, we describe HCRU and costs by 1L treatment in mUC.

METHODS: This retrospective analysis used the Optum Research Database, comprising claims data from ≈8% of US commercially enrolled and 18% of Medicare Advantage populations. Patients were diagnosed with mUC from July 2015 to June 2020 (index date = first claim) with continuous enrollment for 6 months before and ≥6 months after index date. Patients were followed until disenrollment, study end (August 2021), or death. Treatment was categorized as IO monotherapy, cisplatin-based, carboplatin-based, or other. Analyses examined unadjusted all-cause HCRU and costs by treatment and were reported per 100 patients per month (PHPPM) or per patient per month (PPPM).

RESULTS: Of 3006 patients, 1229 (40.9%) received ≥1L treatment. Among treated patients, mean (SD) age was 72.6 (9.8) years, 71.9% were male, and 78.7% had Medicare Advantage. 1L treatment was platinum-based chemotherapy in 57.1% (29.7% cisplatin-based, 27.4% carboplatin-based), IO monotherapy in 27.3%, and other in 15.6%. Median (IQR) number of inpatient (IP) stays and emergency department (ED) visits PHPPM were highest with IO monotherapy (IP stays, 15.08 [3.03-35.71]; ED visits, 26.79 [8.19-61.22]), followed by carboplatin-based (IP stays, 14.08 [5.86-28.04]; ED visits, 22.86 [8.96-53.10]), and cisplatin-based (IP stays, 10.21 [3.49-24.19]; ED visits, 13.70 [4.85-33.04]) treatment. IO monotherapy had the highest median (IQR) healthcare costs PPPM ($12,374.60 [$8,012.03-$17,412.46]), followed by cisplatin-based ($9,544.75; [$5,196.71-$17,947.72]) and carboplatin-based ($8,989.08; [$5,476.20-$13,707.88]) treatment.

CONCLUSIONS: This study indicates, prior to avelumab 1L maintenance approval, ~60% of patients never received anticancer treatment following mUC diagnosis. Among treated patients, HCRU and costs were highest for IO monotherapy followed by platinum-based chemotherapy. Future research should evaluate reasons for lack of treatment and assess HCRU and costs by treatment sequences including avelumab 1LM.