Treatment Patterns, Healthcare Resource Utilization, and Costs of Patients With Locally Advanced and Metastatic Urothelial Cancer in France: A Non-Interventional Database Study

OBJECTIVES: Data on treatment patterns and associated healthcare resource utilization in patients with locally advanced/metastatic urothelial cancer (la/mUC) are limited. With the introduction of new treatment options, it is important to better understand the current management of la/mUC in real-world clinical practice in France. Key study objectives included evaluation of treatment patterns and costs of healthcare resource utilization among patients with la/mUC from 1L start date.

METHODS: This was a descriptive, retrospective study of adult (≥18 years) patients with la/mUC extracted from the Programme de Médicalisation des Systèmes d’Information, a French hospital discharge database, from 01 Jan 2020 to 31 Dec 2022. The present analysis is focused on patients newly diagnosed with la/mUC, with no evidence of treatment for any other type of cancer. Costs were evaluated in different hospital settings (medicine, surgery, and obstetrics [MCO], aftercare and rehabilitation (SSR), and hospital at home [HAD]).

RESULTS: Overall, 59.9% (15,101/25,217) of patients newly diagnosed with la/mUC initiated an identifiable 1L treatment. Of patients who received 1L treatment with at least 6 months potential follow-up, 93.6% (11,130/11,893) received chemotherapy as 1L and 64.5% (7,669/11,893) received only 1L treatment. Avelumab was used as maintenance therapy in 11.9% (497/4,163) and 19.3% (536/2,783) of patients in 2020 and 2022, respectively. For those patients initiating 1L treatment in 2020–2021, the total hospitalization costs (in euros [€]) were €193.1 million in MCO, €10.0 million in HAD, and €7.7 million in SSR. Drugs reimbursed on top of the diagnosis-related groups (i.e. drugs included in the “liste-en-sus”), were mostly administered in MCO, representing approximately 40% of the total costs in MCO (€79.2 million).

CONCLUSIONS: At la/mUC diagnosis, a significant proportion of patients remained untreated. Amongst treated patients, the majority received only 1L treatment indicating a substantial unmet need.