Real-World Economic Burden and Healthcare Resource Utilization of Radical Cystectomy and Trimodal Therapy for Bladder Cancer in the United States

Objective: To leverage contemporary real-world data to offer a comprehensive and longitudinal assessment of cost and healthcare resource utilization in patients with bladder cancer who underwent radical cystectomy (RC) or trimodal therapy (TMT). Methods: Claims data between October 01, 2015, and April 24, 2023, were assessed to determine patient characteristics, costs, and healthcare resource utilization. Patients were followed from 90-days up to 5-years of follow-up. Costs and healthcare utilization were further broken down by place of service and specific cost drivers, and subgroups were assessed to explore aspects of treatment recommended guidelines. Results: Of 1323 patients, 839 underwent RC (median age 71 years; 26.2% female), and 484 received trimodal therapy (median age 75; 26.2% female). Median [IQR] per-patient costs were $70,671 [$55,878-$106,812] for the RC cohort at 90-days follow-up and rose to $211,671 [$138,597-$346,389] by 5-years post-index. For trimodal therapy, total costs were $34,612 [$16,705-$64,263] at 90-days and increased to $274,462 [$186,337-$421,534] by 5-years. At 90-days, median overall visits (inpatient, outpatient, emergency room, or other) were 26 [16-39] for RC and 19 [12-33] for trimodal therapy; overall visits were 163 [119-218] and 186 [144-238] by 5-years, respectively. Conclusion: This analysis reveals that RC costs were primarily driven by inpatient services, particularly inpatient facility costs. For trimodal therapy, outpatient costs predominated, driven by drugs administered and outpatient radiology facilities. The considerable costs and utilization associated with these treatments underscore the need for value-based therapeutic approaches aimed at enhancing patient outcomes.