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Nadia Quignot,1 Heng Jiang,1 Indraraj Umesh Doobaree,2 Jan Lehmann,3 Ola Ghatnekar4 1Evidence & Access, Certara France, Paris, France; 2Evidence & Access, Certara UK, Sheffield, UK; 3Department of Urology, Städtisches Krankenhaus, Kiel, Germany; 4Ferring Pharmaceuticals, Kastrup, DenmarkCorrespondence: Nadia Quignot, Certara France, 54 Rue de Londres, Paris, 75008, France, Tel +3 318 514 2683, Email nadia.quignot@certara.comBackground: Intermediate and high-risk non-muscle-invasive bladder cancer (NMIBC) is typically managed with transurethral resection of the bladder tumour (TURBT) followed by intravesical Bacillus Calmette–Guérin (BCG) immunotherapy; however, NMIBC patients can become refractory or unresponsive to BCG treatment, and/or progress to muscle-invasive bladder cancer (MIBC). Healthcare resource utilization (HCRU) and costs in these patient populations are high.Methods: A retrospective longitudinal cohort design of adult (≥ 18 years) patients with bladder cancer and BCG treatment (01/01/2012– 31/12/2017) was conducted using data from a representative subset of the German statutory health insurance database. During the follow-up period after last BCG, patients were categorized into subgroups of No further NMIBC treatment, Continuous treatment for NMIBC, or MIBC evidence; HCRU and costs were tabulated for each subgroup and for the entire cohort.Results: A total of 1049 patients met the study inclusion criteria (mean age, 70.9 years; 84.8% male). Across the different subgroups, patients showing MIBC evidence had more than two times higher hospitalization rates compared to the other subgroups. Overall, the entire BCG-treated cohort’s total direct medical cost including hospitalizations, outpatient care and drugs was € 33.9 million and € 9250 per patient-year. Cost for patients with MIBC evidence was much higher, at € 17,983 per patient-year, than patients with No further NMIBC treatment (€ 6617) and patients with Continuous treatment for NMIBC (€ 7786). Across the subgroups, hospitalization was the largest driver of cost and contributed the most to cost for those with MIBC evidence.Conclusion: The overall cost burden of this BCG-treated cohort of 1049 patients is high (€ 38 million whereof 4.1 million are indirect costs) over a mean follow-up of 3.9 years; economic burden is especially substantial for patients who fail BCG treatment and those who progress.Keywords: urinary bladder neoplasm, retrospective study, healthcare cost, intravesical instillation, healthcare resource |
