A recent study examined the economic burden incurred by patients enrolled in Medicare who experienced adverse events (AEs) while receiving first-line systemic therapy for locally advanced or metastatic urothelial carcinoma. Researchers presented their findings at AMCP 2023. 

While there is a known correlation between first-line therapies for locally advanced or metastatic urothelial carcinoma and AEs, researchers noted the costs of these AEs are not well characterized in literature. The study was designed to calculate how many patients with locally advanced or metastatic urothelial carcinoma receiving first-line systemic therapy experienced an AE and to characterize overall health care resource utilization (HCRU) and costs relative to those who did not experience AEs. 

As part of a retrospective analysis, researchers used claims data from the US Centers for Medicare & Medicaid Services 100% Medicare Fee-for-Service database between 2015 and 2020. Diagnostic codes were used to identify claims for 11,350 patients with locally advanced or metastatic urothelial carcinoma. Patients were followed from initiation of first-line systemtic therapy through discontinuation, the day before initiation of subsequent line of therapy, end of data availability, end of eligibility, or death. 

Based on a targeted literature review of AEs related to first-line locally advanced or metastatic urothelial carcinoma therapies, 15 AEs were identified and prespecified. Logistic regression was applied to generate a propensity score for each AE and the groups were matched to patients without that AE with replacement, nearest match on propensity score, and exact match on first-line treatment class. Results in the form of all-cause HCRU and 2021 costs per patient per month (PPPM) in US dollars are reported for the overall population. Cohorts with and without AE were matched by propensity score.

The mean age of included patients was 76 years and 77% were male. At diagnosis, 99.9% of patients included in the study had at least one outpatient visit (mean, 16.6 visits). Overall mean all-cause HCRU were $31,937 (30506) PPPM and a prespecified AE occurred in 56.1% of patients. 

Anemia (25.1%), acute kidney injury (13.4%), and dehydration (10.4%) were the most frequent prespecified identified AEs. The mean inpatient, intensive care unit, outpatient, emergency department, and hospice visits for these AEs were significantly greater (P < .01) in patients with vs without AEs. The highest mean PPPM costs among these Aes were for acute kidney injury and were significantly greater in patients with vs without this AE ($18,282 vs $11,525; P < .001).

Researchers found that most patients (56%) with locally advanced or metastatic urothelial carcinoma receiving first-line systemic therapy had at least 1 prespecified AE. Patients with the 3 most frequent AEs had greater HCRU and costs than matched patients without that AE. 

Reference:
Chen R, Xie B, Young C, Yang H, et all. Economic burden among Medicare patients with locally advanced or metastatic urothelial carcinoma who received first-line systemic therapy and experienced adverse events. J Manag Care Spec Pharm. 2023;29(10-a suppl):S1-S137. https://www.jmcp.org/pb-assets/Poster%20Abstract%20Supplements/AMCP2023_PosterAbstractSupplement_0317-1679318682267.pdf