Healthcare resource utilization and associated costs in patients with metastatic urothelial carcinoma: a real-world analysis using German claims data

Abstract

Aims

This retrospective claims data study characterized real-world treatment patterns, healthcare resource utilization (HCRU), and costs in patients with metastatic urothelial carcinoma (mUC) in Germany.

Materials and methods

Continuously insured adults with incident mUC diagnosis (=index; ICD-10: C65–C68/C77–C79) in 2015–2019 were identified from two German claims databases. Patients who received first-line (1 L) treatment within 12 months of index were divided into three mutually exclusive sub-cohorts: platinum-based chemotherapy (PB-CT), non–PB-CT, and immunotherapy (IO). Patient characteristics were assessed during a 24-month baseline period; treatments, HCRU, and costs (of the health insurance fund) per patient-year (ppy) were described during 12-month follow-up.

Results

We identified 3,226 patients with mUC (mean age, 73.8 years; male, 70.8%; mean Elixhauser Comorbidity Index, 17.6); 1,286 (39.9%) received 1 L treatment within 12 months of index. Of these, 825 (64.2%) received PB-CT, 322 (25.0%) non–PB-CT, and 139 (10.8%) IO. On average, treated patients had 5.1 hospitalizations ppy. Most UC-related hospitalizations ppy were observed in the PB-CT cohort (5.8), followed by the non–PB-CT (4.2) and IO (2.3) cohorts. Mean UC-related hospitalization costs ppy were €22,218 in the treated cohort, €24,294 in PB-CT, €19,079 in IO, and €18,530 in non–PB-CT cohorts. Cancer-related prescription costs ppy averaged €6,323 in treated patients, and €25,955 in IO, €4,318 in non–PB-CT, and €4,270 in PB-CT cohorts.

Limitations

We recognized limitations in our study’s sample selection due to unavailable mUC disease status data. We addressed this through an upstream feasibility study conducted in consultation with clinical experts to determine a suitable proxy. Proxies were also used to delineate treatment lines, switches, and discontinuations due to data absence. Furthermore, due to data restrictions, collective dataset analysis was not possible, prompting a meta-analysis for pooled results.

Conclusions

The study shows that mUC is associated with significant HCRU and costs across different types of 1 L systemic therapy.

Keywords:

• Metastatic urothelial carcinoma
• real-world treatment
• healthcare resource utilization
• cost
• disease burden
• claims data

JEL CLASSIFICATION CODES:

• I15
• C82
• I13

Transparency

Declaration of financial/other relationships

GN conducted symposia for Roche Pharma, MEDAC, Pfizer, Bristol Myers Squibb, and AstraZeneca; was part of the following advisory boards: Roche Pharma, Sanofi, Bristol Myers Squibb, Merck, Pfizer, MEDAC, and Janssen; and received reimbursement for travel cost and congress registration from Roche Pharma, Pfizer, Merck, and Bristol Myers Squibb.

MOG reports consulting or advisory roles for AstraZeneca, Bristol Myers Squibb, Ipsen, MSD, ONO, Pfizer, Astellas Pharma, and EUSA; has received reimbursement for travel and accommodations expenses from Bristol Myers Squibb and Merck; has received honoraria from Astellas Pharma, AstraZeneca, Bristol Myers Squibb, MEDAC, MSD, ONO, Novartis, Pfizer, Ipsen, Merck, and EUSA; and has received research funding from Bayer (Inst), Bristol Myers Squibb (Inst), and Intuitive Surgical (Inst).

FH, JK, and AS participated in this study as staff members of Cytel; the work of Cytel in this study was funded by Merck, as part of an alliance between Merck and Pfizer.

UO is employed by Merck Healthcare Germany GmbH, Weiterstadt, Germany, an affiliate of Merck KGaA.

BD is an employee of GWQ and has nothing to declare.

UM was employed by AOK PLUS at the time the study was conducted and has no conflict of interest to declare other than the ones related to the affiliation.

TW is the managing director of IPAM e.V. and has received honoraria/consulting fees from Cytel.

MK is employed by Merck and holds stock/shares in Merck, Novartis, and UCB Biopharma SPRL.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors contributed to the study’s conception and design. FH, JK, and AS performed material preparation, data collection, and analysis. JK wrote the first draft of the manuscript, and all authors commented on previous versions. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work.

Acknowledgements

Editorial support was provided by Katherine Quiroz-Figueroa on behalf of Nucleus Global and funded by Merck and Pfizer.

Data availability statement

The datasets generated and/or analyzed during the current study are not publicly available since the findings of this study are extracted from individual patient records. Data were available for research purposes from the sickness fund upon request, in an anonymized form. Due to restrictions around revealing patients' confidential information, data were used under license for the current study, and so are neither publicly available nor can be shared further.

Ethics approval

No ethical review was required due to the non-interventional, retrospective nature of this study and the anonymity of the analysed dataset.

Consent form

Informed consent was not obtained from the patients due to the anonymized and retrospective nature of the data.

Previous presentations

Some of the results in this manuscript were presented in a poster at ISPOR 2023, 7–10 May 2023; Boston, MA, USA (Poster No. RWD173).

Additional information

Funding

This research was funded by Merck (CrossRef Funder ID: 10.13039/100009945) and was previously conducted under an alliance between Merck and Pfizer. Authors who were employees of the funders were involved in the data analysis, manuscript preparation, and the decision to publish.