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Background

In 2023 in the U.S., 82,290 new cases of bladder cancer and 16,670 related deaths were estimated. Prior analyses assessing the economic burden of locally advanced/metastatic urothelial cancer (la/mUC) in the current and evolving treatment landscape have been limited. This study aimed to estimate the direct medical costs of treating patients with la/mUC, from U.S. Medicare and commercial perspectives.

Methods

A cost model was developed to estimate annual direct medical care costs in patients with la/mUC eligible for first-line platinum-based chemotherapy (PBC) in 2023. Costs (2023 USD) -- including drug acquisition and administration, disease management, and adverse event (AE) management -- were calculated, including subsequent therapy costs. Inputs included estimated number of treated patients per year, treatment duration, progression-free survival and overall survival with various therapies, AEs incidence, and market shares. Efficacy and safety data were sourced from product prescribing information, epidemiology data from Surveillance, Epidemiology, and End Results (SEER) database and published literature. Market share assumptions were based on market research data.

Results

For a hypothetical health plan with 1,000,000 members, 108 and 22 patients with la/mUC from Medicare and commercial perspectives, respectively, were estimated to be eligible for first-line PBC in 2023. With market share data comprising first-line PBC, with and without avelumab (AVE) first-line maintenance (61% and 25%) and enfortumab vedotin (EV) + pembrolizumab (PEM) (for cisplatin-ineligible patients, 14%), annual costs of $16,673,645 ($12,861 per treated member per month) and $4,637,226 ($17,852 per treated member per month) were estimated for Medicare and commercial perspectives, respectively. Drug acquisition costs in first-line represented most of the total costs (Medicare, 75%; commercial, 64%).

Conclusions

Understanding the economic burden associated with la/mUC treatments may facilitate informed decision-making on treatment choice and optimal sequencing. Further real-world studies are needed to assess the impact of these innovative treatments on disease and AE management costs of la/mUC.

Read a Q&A about the study here.