Healthcare resource utilization (HCRU) and costs among US patients (pts) with locally advanced or metastatic urothelial cancer (la/mUC) treated with first-line (1L) treatment regimens: Results from the ELEVATE UC-I study.

Abstract

871 Background: While real-world safety of 1L tx regimens for la/mUC has been previously described, data characterizing HCRU and costs are limited since the introduction of newer tx options. This study assessed all-cause HCRU and costs in pts with la/mUC receiving contemporary 1L txs. Methods: This retrospective cohort study using the Premier Healthcare database included US adult pts diagnosed with la/mUC (Jan 2020-Jun 2024). Pts were stratified by 1L tx: enfortumab vedotin + pembrolizumab (EV + P), platinum-based chemotherapy (PBC; cisplatin- or carboplatin-based) ± avelumab maintenance, and immune checkpoint inhibitor (ICI) monotherapy. Mean all-cause HCRU and costs were assessed from 1L tx initiation through the earliest of either 90 days after 1L discontinuation, initiation of subsequent tx, death, or end of study, and were reported per pt per month (PPPM). Cost components included inpatient (IP) hospitalization; emergency department (ED) visits; outpatient (OP) visits, including medications; and total costs (IP + OP). Length of stay (LOS) was defined as number of hospitalization days. Results: Among 7,984 pts, median age was 72 years (IQR 64-78); 73% were male and 83% were White. Mean all-cause HCRU and costs by 1L tx regimen are shown in the Table. EV + P had the highest mean total PPPM all-cause costs, largely driven by medication expenses and accounting for 89% of PPPM OP visit costs. PBC ± avelumab treated cohorts had the lowest total PPPM costs, reflecting the fixed duration of PBC and lower drug costs. Conclusions: HCRU and economic burden of la/mUC are substantial and vary by 1L tx type. EV+P was associated with the highest OP and total costs. These findings may inform resource allocation planning as new tx are incorporated into routine care. Future studies should assess the impact of comorbidities and disease status on HCRU. All-cause HCRU and costs by 1L tx regimen for la/mUC. HCRU & Costs (2024 USD) Overall Cohort(n=7,984) EV+P (n=343) Cisplatin-based chemo + avelumab (n=223) Cisplatin-based chemoalone (n=3,608) Carboplatin-based chemo + avelumab (n=201) Carboplatin-based chemo alone(n=1,250) ICI monotherapy (n=2,359) Median follow-up time, days 140 147 298 139 278 112 154 Pts with IP hospitalization, n (%) 3,582 (44.9) 129 (37.6) 90(40.4) 1,663(46.1) 85(42.3) 647(51.8) 968(41.0) Mean PPPM LOS for IP hospitalization, days 0.86 0.75 0.37 1.01 0.34 1.91 0.60 Pts with ED visits, n (%) 1,930 (24.2) 78(22.7) 88(39.5) 796(22.1) 70(34.8) 322(25.8) 576(24.4) Mean PPPM ED visits 0.07 0.06 0.06 0.08 0.05 0.10 0.06 Mean PPPM costs, IP hospitalization 2,858 2,233 1,106 3,831 935 5,471 1,815 Mean PPPM costs, ED visits 109 79 92 115 100 174 92 Mean PPPM costs, OP visits 9,667 34,137 11,458 5,454 11,203 5,395 11,733 Mean PPPM costs, Total (IP + OP) 12,525 36,370 12,564 9,285 12,138 10,866 13,549