# Real-World Retrospective Study of Clinical and Economic Outcomes Among Patients with Locally Advanced or Metastatic Urothelial Carcinoma Treated with First-Line Systemic Anti-Cancer Therapies in the United States: Results from the IMPACT UC-III Study

## TL;DR

This study analyzed real-world treatment outcomes and costs for bladder cancer patients in the US, highlighting how treatment choices and economic factors vary based on patient characteristics.

## Contribution

The study provides new insights into treatment patterns, socioeconomic influences, and cost drivers in first-line therapies for advanced bladder cancer using real-world data.

## Key findings

- Outpatient visits were the main cost driver across all treatment types.
- Treatment choices were influenced by factors like renal disease and socioeconomic status.
- Median monthly costs varied significantly between chemotherapy, immunotherapy, and other therapies.

## Abstract

This study evaluated real-world outcomes of first-line treatments for advanced or metastatic bladder cancer in the US from 2020 to 2023, using de-identified health records from 2820 patients. Treatments included chemotherapy (37%), immunotherapy (39%), and other therapies (24%). Socioeconomic factors and conditions like kidney disease influenced treatment choices. Outpatient visits emerged as a major cost driver, with costs varying between treatment types. Findings emphasize the importance of patient characteristics in treatment decisions and the economic impact of therapies. This study offers insights that can influence future research, policy, and real-world applications. Policymakers may use these findings to create guidelines ensuring equitable access to effective cancer treatments. Clinicians can improve decision making by considering individual patient characteristics like age and socio-economic status. Insurance providers might adjust coverage plans to support beneficial therapies in the first line, emphasizing cost-effective management for advanced or metastatic bladder cancer care.

This retrospective cohort study evaluated characteristics, treatment patterns, and clinical outcomes in adults with locally advanced/metastatic urothelial carcinoma (la/mUC) receiving first-line (1L) systemic treatment with or without avelumab 1L maintenance (1LM) between January 2020 and July 2023. The index date was the first date with a claim for 1L systemic therapy after a la/mUC diagnosis. Patients with continuous health plan enrollment for ≥6 months before and ≥1 month after the index date were identified from Carelon Research’s Healthcare Integrated Research Database. Of 2820 patients receiving 1L treatment, 37.0% received platinum-based chemotherapy (PBC); 39.0%, immuno-oncology (IO) monotherapy; and 24.0%, other therapies. Renal disease and other comorbidities influenced 1L regimen choice. Healthcare resource utilization (HCRU) and costs were reported for patients receiving second-line (2L) treatment. HCRU was high in 32.8% of patients (926 of 2820) who received 2L treatment. Median all-cause direct medical costs per patient per month were USD 15,859, USD 19,781, USD 11,346, and USD 9516 for 1L PBC, 1L PBC + avelumab 1LM, 1L IO monotherapy, and 1L other therapies, respectively. Most direct healthcare costs were attributed to all-cause outpatient visits.