Costs of Care for Patients Receiving Chemotherapy for Advanced Bladder Cancer


Journal of Clinical Pathways. 2017:3(10):63-70.


Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX; Merck & Co., Inc., Kenilworth, NJ; Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.


Dr Kyle Flannery

Merck & Co.

351 N Sumneytown Pike

North Wales, PA

Phone: (267) 305-3392



Drs Cao, He, Zhong, and Flannery are employees of Merck & Co, Inc. Drs Kamat and Shah have no relevant financial relationships to disclose.

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Abstract: There is limited information on chemotherapy treatment patterns, health care visits, costs, and survival among patients with advanced bladder cancer. This was a retrospective cohort study of patients using the SEER-Medicare data set. First-line (1L) and second-line (2L) chemotherapy treatment patterns; health care visits; costs of health care in 2016 US dollars; and survival patterns were calculated from the index therapy date. Of 1215 patients diagnosed with advanced bladder cancer, 411 (33.8%) received 1L chemotherapy and 189 (15.6%) subsequently received 2L chemotherapy. During the 1L and 2L treatment windows, totals of 28.5 and 22.7 visits per patient were recorded, respectively. The total costs of cancer care during the 1L and 2L treatment windows were $36,790 and $26,730, respectively, of which more than $10,000 in costs were paid directly by the patient. Systemic therapy for bladder cancer is costly and should be weighed against the clinical outcomes likely to be achieved. Neither 1L nor 2L patients in this study experienced a median survival beyond 1 year following treatment initiation.

Acknowledgements: The authors wish to thank Anna Kaufman, MPH, in collaboration with ScribCo, for medical writing assistance.

Funding: This work was financially supported by Merck & Co, Inc.

The most common types of cancer in the United States are breast, lung and bronchus, prostate, and colon and rectum, with incidences in the range of 40 to 67 cases per 100,000 individuals, and urinary bladder cancer, with an incidence of 20 cases per 100,000 individuals, based on data for the period between 2010 and 2014.1

Bladder cancer incidence is much higher in individuals aged 65 years or older than in those aged younger than 65 years (122 vs 5.1 per 100,000).1 The cost burden of  bladder cancer in the United States largely falls on individuals receiving Medicare. 

Between 2007 and 2013, distant cancers that had spread from the original tumor accounted for 4% of all bladder cancer diagnoses.1 Cisplatin-based combination chemotherapy is the standard of care for first-line (1L) systemic therapy.2 Treatment of advanced bladder cancer is largely palliative, and its costs should be weighed against the limited survival benefits: The 5-year survival rate of advanced bladder cancer is 5%.3

There are few published studies of the health care costs and outcomes of chemotherapy treatment of advanced bladder cancer. Our objective was to report treatment patterns; the source, setting, and division of costs; and survival outcomes for patients receiving systemic chemotherapy for advanced bladder cancer. The results of this study will also represent a baseline against which to assess the costs and outcomes of new immunotherapies likely to emerge in the coming years.


Study Design

This was a retrospective cohort study of patients identified in the SEER-Medicare database. The SEER-Medicare linked database contains clinical information on incident cancer cases in the United States between 1991 and 2011 from the SEER cancer registry, and longitudinal administrative Medicare claims from 1991 to 2013 for Medicare Parts A and B enrollees. Patients with a new diagnosis of advanced bladder cancer during the patient identification period—from January 1, 2007 through December 31, 2011—who received 1L or second-line (2L) chemotherapy were followed for a minimum of 24 months. Treatment regimens, health care visits, costs, and survival after beginning 1L and 2L chemotherapy were determined. 

The index diagnosis date was defined as the date of the advanced diagnosis. The baseline period consisted of the 6 months prior to the index diagnosis date. Patient demographic characteristics were documented in the baseline period. The index therapy date was defined as the date of chemotherapy (1L or 2L) initiation. The treatment exposure window was defined as the time from the first dose of chemotherapy through the end of the last cycle in that line of therapy. Patients included in the study were followed until the earliest date of death, health maintenance organization (HMO) enrollment, last known date of follow-up in the SEER-Medicare database, or the end of the study period (December 31, 2013). There was no minimum or maximum follow-up required for the analysis. 

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