Healthcare Resource Utilization and Cost Burden of BCG-Treated Non-Muscle Invasive Bladder Cancer Patients in Germany: A Retrospective Claims Analysis

• Published in: ClinicoEconomics and outcomes research 2023-01, Vol.15, p.227-237
• Main Authors: Quignot, Nadia, Jiang, Heng, Doobaree, Indraraj Umesh, Lehmann, Jan, Ghatnekar, Ola
• Format: Article
• Language: English
• Subjects: Analysis; BCG; BCG vaccines; Bladder cancer; Cancer; Cancer patients; Cancer therapies; Care and treatment; Chemotherapy; Codes; Comorbidity; Costs; Disease; Economic aspects; Health care; Health services utilization; healthcare cost; healthcare resource; Hospitalization; Hospitals; Immunotherapy; intravesical instillation; Medical care; Medical care, Cost of; Medical research; Medicine, Experimental; Metastasis; Original Research; Patients; Pharmaceutical industry; Radiation therapy; retrospective study; urinary bladder neoplasm; Urogenital system; Utilization
• ISSN: 1178-6981; 1178-6981
• DOI: 10.2147/CEOR.S398180

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. 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 , or ; HCRU and costs were tabulated for each subgroup and for the entire cohort. A total of 1049 patients met the study inclusion criteria (mean age, 70.9 years; 84.8% male). Across the different subgroups, patients showing 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 was much higher, at €17,983 per patient-year, than patients with (€6617) and patients with (€7786). Across the subgroups, hospitalization was the largest driver of cost and contributed the most to cost for those with . 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.