Clinical and Economic Outcomes in Patients With Metastatic Urothelial Carcinoma Receiving First-Line Systemic Treatment (the IMPACT UC I Study)

• Published in: The oncologist (Dayton, Ohio) Vol. 28; no. 9; pp. 790 - 798
• Main Authors: Bilen, Mehmet A, Robinson, Scott B, Schroeder, Amy, Peng, Jing, Kim, Ruth, Liu, Frank X, Bhanegaonkar, Abhijeet
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 07.09.2023
• Subjects: Bladder cancer; Cancer; Carcinoma; Chemotherapy; Cisplatin; Development and progression; Drug approval; Drug therapy; Economic aspects; Genitourinary Cancer; Immunotherapy; Medical care; Medical care, Cost of; Metastasis; Patient outcomes; Pharmaceutical industry; Statistics; Utilization; United States; Germany; first-line treatment; immune checkpoint inhibitors; Medicare; metastatic urothelial carcinoma; treatment patterns; healthcare resource utilization
• ISSN: 1083-7159; 1549-490X
• DOI: 10.1093/oncolo/oyad174

Abstract Background The IMPACT UC I study assessed real-world treatment patterns, outcomes, healthcare resource utilization (HCRU), and costs in patients with metastatic urothelial carcinoma (mUC) receiving first-line (1L) systemic treatment after the FDA approval of 1L immune checkpoint inhibitor (ICI) monotherapy. Patients and Methods This retrospective study used 100% Medicare fee-for-service claims from 1/1/2015 to 6/30/2019 to identify patients aged ≥18 years diagnosed with UC with evidence of metastatic disease, continuously enrolled for 6 months before and after initial diagnosis. Patients were grouped by 1L treatment: cisplatin-containing chemotherapy, carboplatin-containing chemotherapy, ICI monotherapy, or nonplatinum-containing therapy. Unadjusted time on 1L treatment (TOT), overall survival (OS), HCRU, and total healthcare costs were analyzed. Results Of 18 888 patients with mUC, 8630 (45.7%) had received identified 1L systemic treatment; platinum-containing chemotherapy was the most common (cisplatin-containing chemotherapy, 37.6%; carboplatin-containing chemotherapy, 30.2%). Cisplatin- and carboplatin-containing chemotherapy had the shortest time-to-treatment initiation (median, 1.7-3.0 months) and longest TOT (median, 4.0-4.3 months). Median OS was longest with cisplatin-containing chemotherapy (20.0 months) and shortest with ICI monotherapy (7.6 months). Cisplatin- and carboplatin-containing chemotherapy were associated with highest HCRU; total healthcare costs were approximately 2-fold higher with ICI monotherapy vs other 1L treatments ($10 359 vs $5042-$5709 per patient per month). Conclusion 1L platinum-containing chemotherapy resulted in the longest median OS and highest HCRU, whereas 1L ICI treatment had the shortest median OS and the highest costs. Over 50% of patients diagnosed with advanced UC (aUC) received no systemic therapy, highlighting the importance of optimal 1L treatment decisions in aUC. The IMPACT UC I study assessed real-world treatment patterns, outcomes, healthcare resource utilization, and costs in patients with metastatic urothelial carcinoma receiving first-line systemic treatment after the FDA approval of first-line immune checkpoint inhibitor monotherapy.