Treatment Patterns, Healthcare Resource Utilization, and Costs Among Patients Diagnosed With Locally Advanced/Metastatic Urothelial Carcinoma Prior to Receiving Enfortumab Vedotin: A Real-World Evidence Study

Abstract

Objective: To describe real-world patient characteristics, prior treatment patterns, and associated healthcare resource utilization (HRU) and costs among patients with locally advanced/metastatic urothelial carcinoma (la/mUC) treated with enfortumab vedotin (EV).

Methods: This retrospective study used the United States (US) Centers for Medicare and Medicaid Services 100% Medicare claims data from 2015 to 2020. Included patients had a diagnosis of la/mUC and received treatment with EV. The index date was the EV initiation date. Endpoints included HRU and costs 12 months before the index date (baseline period) and treatment patterns before EV initiation. Results were summarized descriptively using means and standard deviations for continuous variables, and frequency counts and percentages for categorical variables.

Results: Among the 529 included patients, the mean age at the time of EV initiation was 76.5 years. Most patients were White (88.1%) and male (77.1%). Common comorbidities were hypertension (85.1%), renal disease (65.2%), and peripheral vascular disease (42.5%). Platinum-based chemotherapy was the most frequent therapy two lines before EV initiation (43.9%). The most frequent therapy in the line before EV initiation was PD-1/L1 inhibitors (61.4%). The median duration of EV therapy was 4.1 months. The mean all-cause healthcare cost during the baseline period was $106 258 per patient, and 86% had at least one outpatient visit.

Conclusions: This real-world study demonstrated that most US patients with la/mUC received platinum-based chemotherapy or a PD-1/L1 inhibitor prior to EV therapy from 2015 to 2020. HRU and costs 12 months before EV initiation suggest a substantial burden in this population. Long-term studies with more recent data are warranted.

Keywords: enfortumab vedotin; healthcare costs; metastatic urothelial carcinoma; retrospective study; treatment patterns.

FIGURE 1

Patient selection flowchart. EV, enfortumab vedotin; UC, urothelial carcinoma.

FIGURE 2

Treatment patterns among EV‐treated patients with la/mUC in the Medicare database. −1L (EVi), one line prior to index EV therapy; –2L (EVi), two lines prior to index EV therapy; EV, enfortumab vedotin; la/mUC, locally advanced/metastatic urothelial carcinoma; PD‐1/L1, programmed death receptor‐1 or programmed death‐ligand 1 inhibitor. ^†−2L EVi and –1L EVi indicate treatment regimens before the index treatment, which were assessed during the baseline period. The baseline period was defined as 12 months before the index date or the period since the initial la/mUC diagnosis, whichever was longer. ^‡EVi indicates the index treatment, which was defined as the first EV prescription. ^§Post‐EVi indicates treatment regimens after the index treatment.

FIGURE 3

Duration of EV therapy among EV‐treated patients with la/mUC in the Medicare database. CI, confidence interval; EV, enfortumab vedotin; la/mUC, locally advanced/metastatic urothelial carcinoma; SD, standard deviation. ^†Duration of EV therapy was defined as the time between EV initiation and discontinuation or death. Patients were censored if EV discontinuation was not observed at end of enrollment or end of data, whichever came first.