The IMPACT UC II study assessed real-world overall survival (OS), first-line (1 L) to second-line (2 L) progression, healthcare resource utilization (HCRU), and costs in patients with metastatic urothelial cancer (mUC) before US approval of avelumab 1 L maintenance in June 2020. Claims data from adults diagnosed with mUC from July 2015 to June 2020 were analyzed retrospectively in three 1 L cohorts: cisplatin-based chemotherapy, carboplatin-based chemotherapy, and immuno-oncology (IO) monotherapy. Patients were observed from mUC diagnosis until death, disenrollment, or study end (August 2021). 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). Of 3006 patients with mUC, 1037 received 1 L treatment: cisplatin-based in 365 (35. 2%), carboplatin-based in 337 (32. 5%), and IO in 335 (32. 3%). Compared with 1 L 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 1 L-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). Approximately one-third of patients with mUC in this population received 1 L therapy. Mortality, HCRU, and costs were higher with IO monotherapy vs platinum-based chemotherapy.
Bilen et al. (Wed,) studied this question.