P1 Economic Burden of Recurrence among Patients with High-Risk Non-Muscle-Invasive Bladder Cancer who Received Bacillus Calmette-Guérin in the United States: A SEER-Medicare Study

Objectives This study assessed the impact of recurrence on healthcare resource utilization (HCRU) and costs in patients with high-risk non-muscle-invasive bladder cancer (HR-NMIBC) who received Bacillus Calmette-Guérin (BCG). Methods A retrospective cohort study was conducted using SEER-Medicare data (2007-2020). Patients with HR-NMIBC (TisN0M0, T1N0M0, or high-grade TaN0M0) who received BCG were stratified into recurrence (i.e., patients with NMIBC recurrence, muscle-invasive bladder cancer progression, or distant metastasis) and non-recurrence cohorts. In the recurrence cohort, the index date was defined as 30 days before the first recurrence to capture recurrence-related HCRU before recurrence; in the non-recurrence cohort, the index date was randomly assigned to match the time from BCG initiation to recurrence in the recurrence cohort. Post-index all-cause HCRU, including inpatient (IP) admissions, outpatient (OP) visits, emergency department (ED) visits and skilled nursing facility (SNF) visits, and associated costs (2023 USD) were summarized on a per-patient-per-month (PPPM) basis and compared between cohorts using a generalized linear regression model. Results The study included 2,164 and 2,586 patients in recurrence and non-recurrence cohorts, respectively (median follow-up: 23.82 and 26.23 months). Significantly higher proportions of patients incurred ≥1 all-cause HCRU in recurrence vs. non-recurrence cohorts (IP: 66.2% vs. 47.9%, OP: 99.6% vs. 97.1%, ED: 54.6% vs. 45.2%, SNF: 20.7% vs. 18.0%; all p<0.05). Among patients who incurred HCRU, mean numbers of OP and ED visits PPPM were significantly higher in the recurrence cohort (OP: 2.93 vs. 1.88, ED: 0.17 vs. 0.12; both p<0.05). All-cause PPPM healthcare costs were also higher in the recurrence cohort (total: $5,058 vs. $2,207; IP: $2,472 vs. $980; OP: $1,548 vs. $504; ED: $80 vs. $41, SNF: $270 vs. $177; others: $687 vs. $505; all p<0.05).