Real-world economic burden of disease recurrence in patients with muscle-invasive bladder cancer: A population-level claims-based analysis.

Background: Bladder cancer is a common cancer with significant morbidity, mortality, and economic cost. Muscle-invasive bladder cancer (MIBC) is typically managed with radical cystectomy (RC). Despite its curative intent, a considerable proportion of patients experience recurrence after RC. The economic impact of recurrence among patients with surgically resected MIBC has not been described.

Objective: To assess health care resource utilization (HCRU) and costs among patients with surgically resected MIBC in the United States, including the impact of disease recurrence.

Methods: In this retrospective, observational study, the Surveillance, Epidemiology, and End Results-Medicare database (2007-2020) was used to identify patients diagnosed with T2-T4aN0M0 or T1-T4aN1M0 MIBC who underwent RC in the United States. Index date was the date of RC. Patients were stratified by whether they experienced recurrence following surgical resection. The index date for patients with recurrence was defined as 30 days prior to recurrence, and for patients without recurrence, the index date was drawn from a distribution to match the time window between surgical resection and the index date in the recurrence cohort. Patients were followed from the index date until the end of data availability, continuous enrollment, or death. Rates of HCRU per patient per year (PPPY) and mean health care costs per patient per month (PPPM; in 2022 USD) were summarized and compared between cohorts.

Results: A total of 1,149 patients met selection criteria. Patients had a median of 2.6 years of follow-up. Demographic and clinical characteristics were generally similar between patients with (n = 503) and without recurrence (n = 602), with few exceptions. Patients with recurrence (compared with those without) were more likely to have had stage IIIA disease (47.9% vs 32.7%) and a proxy for cisplatin contraindications (54.1% vs 47.5%, both P < 0.05), which included renal insufficiency, peripheral neuropathy, sensorineural hearing loss, or cardiac disease. Following index, patients with surgically resected MIBC had 3.5 all-cause inpatient admissions, 1.0 all-cause emergency department (ED) visits, and 25.8 all-cause outpatient visits PPPY. Patients with recurrence had higher rates of all-cause HCRU than patients without recurrence after index, including inpatient admissions (adjusted incidence rate ratio: 2.4), ED visits (2.7), and outpatient visits (2.0; all P < 0.001). The total all-cause medical costs PPPM were $11,250 and were higher for patients with vs without recurrence ($10,030 vs $3,343; adjusted cost difference: $7,191), largely because of higher inpatient admissions costs ($6,654 vs $2,102; adjusted cost difference: $4,542; both P < 0.001).

Conclusions: Surgically resected MIBC was associated with a substantial economic burden with disease recurrence experiencing higher HCRU and health care costs. These findings underscore the need for novel and effective therapies that can prevent or delay disease recurrence for patients with MIBC.