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

Figures & data

Figure 1. Study overview. Abbreviation. UC, urothelial carcinoma.

Figure 2. Study cohort overview. Abbreviations. 1L, first line; ICD-10, International Classification of Diseases, Tenth Revision; IO, immunotherapy; mUC, metastatic urothelial carcinoma; PB-CT, platinum-based chemotherapy; UC, urothelial carcinoma.

Table 1. Patient characteristics and comorbidities.

	Patients with mUC	Treated patients	PB-CT cohort	IO cohort	Non–PB-CT cohort
	N = 3,226	n = 1,286	n = 825	n = 139	n = 322
Average observation length within 12 months of follow-up, mean (SD), years	0.6 (0.4)	0.8 (0.3)	0.8 (0.3)	0.7 (0.3)	0.7 (0.3)
Total patient-years within 12 months of follow-up	1,885.7	1,014.7	685.4	98.7	230.7
Age (at index), mean (SD), years	73.8 (10.8)	68.8 (10.4)	66.9 (10.5)	72.7 (10.0)	72.0 (8.8)
Males, %	70.8	74.0	73.7	71.9	75.8
CCI (24-month baseline)
Mean (SD)	6.3 (3.8)	5.5 (3.5)	5.1 (3.4)	6.5 (3.7)	6.2 (3.7)
Median (range)	6 (0–19)	5 (0–18)	4 (0–18)	6 (0–16)	5 (0–18)
ECI (24-month baseline)
Mean (SD)	17.6 (11.4)	15.2 (10.7)	13.8 (10.3)	19.0 (11.8)	17.3 (10.7)
Median (range)	16 (−7 to 66)	14 (−3 to 53)	11 (−3 to 48)	17 (−3 to 53)	16 (0–52)

Abbreviations. CCI, Charlson Comorbidity Index; ECI, Elixhauser Comorbidity Index; IO, immunotherapy; mUC, metastatic urothelial carcinoma; PB-CT, platinum-based chemotherapy.

Table 2. Hospitalizations during the 12-month follow-up period.

	Patients with mUC	Treated patients	PB-CT cohort	IO cohort	Non–PB-CT cohort
	N = 3,226	n = 1,286	n = 825	n = 139	n = 322
All-cause hospitalizations
Patients with ≥1 hospitalization, n (%)	3,136 (97.2)	1,275 (99.1)	824 (99.9)	133 (95.7)	318 (98.8)
Number of hospitalizations ppy, mean (95% CI)	7.3 (7.1–7.5)	9.1 (8.8–9.4)	9.6 (9.2–10.0)	6.5 (5.8–7.4)	8.6 (8.3–9.5)
Number of hospitalization days ppy, mean (95% CI)	81.0 (77.8–83.4)	89.9 (85.1–93.3)	89.4 (84.0–93.4)	81.2 (66.7–98.3)	95.1 (90.8–109.6)
Hospitalization length for admitted patients, mean (SD)	48.7 (47.6)	71.5 (59.7)	74.4 (58.7)	60.0 (65.5)	68.9 (59.5)
Average proportion of hospitalization days, mean (95% CI)	0.39 (0.37–0.40)	0.30 (0.29–0.31)	0.28 (0.26–0.29)	0.28 (0.24–0.33)	0.34 (0.33–0.39)
Hospitalizations with UC as main diagnosis
Patients with ≥1 hospitalization, n (%)	2,148 (66.6)	1,040 (80.9)	718 (87.0)	97 (69.8)	225 (69.9)
Number of hospitalizations ppy, mean (95% CI)	3.6 (3.4–3.8)	5.1 (4.9–5.4)	5.8 (5.6–6.3)	2.3 (1.8–2.7)	4.2 (3.7–4.8)
Number of hospitalization days ppy, mean (95% CI)	40.0 (38.0–41.8)	46.7 (43.7–49.3)	50.3 (47.1–53.8)	29.7 (23.1–39.1)	43.2 (39.8–52.4)
Hospitalization length for admitted patients, mean (SD)	35.1 (33.0)	45.5 (40.0)	47.9 (40.3)	30.5 (36.4)	44.2 (39.4)
Average proportion of hospitalization days, mean (95% CI)	0.20 (0.18–0.21)	0.15 (0.14–0.16)	0.16 (0.16–0.18)	0.13 (0.11–0.18)	0.17 (0.14–0.19)

Abbreviations. IO, immunotherapy; mUC, metastatic urothelial carcinoma; PB-CT, platinum-based chemotherapy; ppy, per patient-year; UC, urothelial carcinoma.

Figure 3. Percentage of patients with outpatient visits to general practitioner or specialists during follow-up. Abbreviations. IO, immunotherapy; mUC, metastatic urothelial carcinoma; PB-CT, platinum-based chemotherapy.

Table 3. Number of non-retired patients and work absence.

	Patients with mUC	Treated patients	PB-CT cohort	IO cohort	Non–PB-CT cohort
	N = 1,852^a	n = 637	n = 393	n = 67	n = 177
Non-retired patients, n (%)	260 (14.0)	158 (24.8)	114 (29.0)	11 (16.4)	33 (18.6)
Work absence
Patients with ≥1 work absence, n (%)^b	135 (37.5)	104 (65.8)	82 (71.9)	4 (36.4)	18 (54.5)
Number of work absence days ppy, mean (95% CI)	98.9 (77.3–120.5)	115.3 (88.7–141.8)	130.3 (96.7–163.8)	52.8 (−24.6 to 130.2)	77.3 (36.1–118.4)
Work absence related to UC
Patients with ≥1 work absence, n (%)	129 (49.6)	100 (63.3)	80 (70.2)	4 (36.4)	16 (48.5)
Number of work absence days ppy, mean (95% CI)	93.0 (71.9–114.1)	108.0 (82.2–133.9)	127.5 (94.6–160.3)	51.5 (−25.6 to 128.7)	53.3 (18.1–88.5)

Abbreviations. IO, immunotherapy; mUC, metastatic urothelial carcinoma; PB-CT, platinum-based chemotherapy; ppy, per patient-year; UC, urothelial carcinoma.

^aBecause the data were not available in the GWQ database, analyses were performed using only the AOK PLUS data.

^bPercentages were calculated in the working population only.

Table 4. UC-related surgical interventions.

	Patients with mUC	Treated patients	PB-CT cohort	IO cohort	Non–PB-CT cohort
	N = 3,226	n = 1,286	n = 825	n = 139	n = 322
Any UC-related surgical intervention, n (%)	2,126 (65.9)	891 (69.3)	582 (70.6)	93 (66.9)	216 (67.1)
Transurethral resection of the bladder	1,666 (51.6)	719 (55.9)	488 (59.2)	65 (46.8)	166 (51.6)
Continuous irrigation of the bladder	1,054 (32.7)	444 (34.5)	309 (37.5)	40 (28.8)	95 (29.5)
Cystoscopy	723 (22.4)	296 (23.0)	183 (22.2)	45 (32.4)	68 (21.1)
Ureterorenoscopy	723 (22.4)	113 (8.8)	69 (8.4)	19 (13.7)	25 (7.8)
Ureter splint	721 (22.3)	296 (23.0)	183 (22.2)	45 (32.4)	68 (21.1)
Transfusions	574 (17.8)	192 (14.9)	102 (12.4)	28 (20.1)	62 (19.3)
Cystectomy	430 (13.3)	211 (16.4)	129 (15.6)	29 (20.9)	53 (16.5)
Cutaneous urinary drainage	394 (12.2)	177 (13.8)	96 (11.6)	29 (20.9)	52 (16.2)
Percutaneous nephrostomy	378 (11.7)	134 (10.4)	85 (10.3)	20 (14.4)	29 (9.0)
Nephrectomy	204 (6.3)	105 (8.2)	52 (6.3)	23 (16.6)	30 (9.3)
Surgical evacuation of a urinary bladder tamponade	195 (6.0)	70 (5.4)	49 (5.9)	3 (2.2)	18 (5.6)
Lymph node dissection	163 (5.1)	84 (6.5)	56 (6.8)	10 (7.2)	18 (5.6)
Radiotherapy	111 (3.4)	35 (2.7)	15 (1.8)	8 (5.8)	12 (3.7)
Bladder replacement	89 (2.8)	65 (5.1)	52 (6.3)	4 (2.9)	9 (2.8)
Ureterocutaneostomy	73 (2.3)	22 (1.7)	10 (1.2)	4 (2.9)	8 (2.5)

Abbreviations. IO, immunotherapy; mUC, metastatic urothelial carcinoma; PB-CT, platinum-based chemotherapy; UC, urothelial carcinoma.

Figure 4. All-cause outpatient prescriptions costs and all-cause hospitalization costs ppy during the 12-month follow-up period. Abbreviations. IO, immunotherapy; mUC, metastatic urothelial carcinoma; PB-CT, platinum-based chemotherapy; ppy, per patient-year.

Figure 5. Percentage of UC-related costs in all-cause hospitalization and prescription costs. Hospitalizations were considered UC related if the main or primary International Classification of Diseases, Tenth Revision code was UC. Prescriptions were considered UC related if the patient had a cancer-related ATC code or OPS in the outpatient setting (all “L” ATC codes [antineoplastic and immunomodulating agents] and corresponding OPS medication codes [6-00]; additionally, OPS 8-54 [cytostatic chemotherapy/immunotherapy] was reported, without consideration of 8-541 [locoregional therapy] and 8-548 [highly active antiretroviral therapy]). Abbreviations. ATC, Anatomical Therapeutic Chemical; IO, immunotherapy; mUC, metastatic urothelial carcinoma; OPS, operation and procedure key; PB-CT, platinum-based chemotherapy; UC, urothelial carcinoma.