OBJECTIVES : To describe patient characteristics, comorbidities, treatments patterns, healthcare resource utilization (HRU) and costs in locally advanced or metastatic urothelial carcinoma patients.

METHODS : Eligible patients were identified in the HealthCore Integrated Research Environment (HIRE) if they had ≥1 ICD-9-CM or ICD-10 diagnosis code for urothelial carcinoma and were continuously enrolled for ≥6 months during the study period (2010 - 2016). Locally advanced or metastatic disease (mUC) staging was confirmed by patient record linkage with 3 US state cancer registries and HIRE-Oncology dataset. The index date was the date of first urothelial carcinoma diagnosis for newly diagnosed patients and the 180^th day of continuous enrollment for all others. All HRU and costs were calculated on a per-patient per-year basis (PPPY) and adjusted to 2016 US dollars. Patient characteristics were described at index date, and treatments, HRU and costs were described during follow-up.

RESULTS : A total of 791 patients with confirmed mUC were identified, 430 (54.4%) of which were newly diagnosed. Mean age ±SD was 69.3 ±11.6 years (median = 70) and 69.9% were men. The mean Deyo-Charlson Comorbidity Index was 3.3 ±3.7 (median = 2). Median follow-up was 15 months. Most patients had ≥1 surgical procedure (61.8 %), and/or received anti-cancer therapy (60.9%); use of radiation therapy was less frequent (19.6%). Patients with mUC had substantial HRU with medians of 72.5 outpatient visits (interquartile range [IQR]: 41.8-110.0) and 1.6 hospitalizations (IQR: 0.5-3.8) PPPY. Median all-cause medical costs amounted to $76,952 (IQR: $34,069; $148,787) PPPY, mainly driven by inpatient costs (36.9%).

CONCLUSIONS : This analysis describes the clinical management and costs of mUC patients within a managed care environment. It demonstrates that mUC is associated with substantial healthcare resource use and costs, driven primarily by hospitalizations in a mostly elderly and highly comorbid patient population.