Abstract
IMPORTANCE: Real-world data about treatment sequencing and economic and clinical outcomes in patients with metastatic urothelial cancer (mUC) are limited. OBJECTIVE: The IMPACT UC II study evaluated real-world overall survival (OS), first-line (1L) to second-line (2L) progression, and healthcare resource utilization (HCRU) and costs in patients with mUC before US approval of avelumab 1L maintenance in June 2020. DESIGN: Retrospective study. SETTING: US insurance claims data from the Optum Research Database. PARTICIPANTS: Adults diagnosed with mUC from July 2015 to June 2020, observed until death, disenrollment, or study end (August 2021). INTERVENTION(S) OR EXPOSURE(S): Three cohorts were defined based on 1L treatment received: cisplatin-based chemotherapy, carboplatin-based chemotherapy, or immuno-oncology (IO) monotherapy. MAIN OUTCOME(S) AND MEASURE(S): Analyses included OS (multivariable Cox proportional hazards),1L-to-2L progression (incidence rates), HCRU and costs (medians), and multivariable-adjusted cumulative 24-month predicted costs (Lin regression models). RESULTS: Of 3006 patients with mUC, 1037 received 1L treatment: cisplatin-based in 365 (35.2%), carboplatin-based in 337 (32.5%), and IO in 335 (32.3%). Compared with 1L cisplatin-based chemotherapy, mortality risk (hazard ratio [95% CI]) was doubled with IO monotherapy (2.0 [1.6-2.5]) and 1.5-times higher with carboplatin-based chemotherapy (1.5 [1.3-1.9]). The 1L-to-2L progression rate per 100 person-years was highest in patients receiving carboplatin-based chemotherapy (74.4) compared with cisplatin-based chemotherapy (51.9) and IO monotherapy (29.8). All-cause HCRU was lowest with carboplatin-based chemotherapy. Median all-cause and mUC-related costs were highest with IO monotherapy (mUC-related per patient per month: IO, $9739; cisplatin-based, $6687; carboplatin-based, $5219) as were cumulative 24-month predicted costs (mUC-related: IO, $157 595; cisplatin-based $122 351; carboplatin-based, $112 412). CONCLUSIONS: Approximately one-third of patients with mUC in this population received 1L therapy. Mortality, HCRU, and costs were higher with IO monotherapy vs platinum-based chemotherapy. RELEVANCE: Results provide baseline data for future studies evaluating the impact of newer treatment options for patients with mUC.