The Impact of Progression on Healthcare Resource Utilization and Costs Among Patients with High-Grade Non-Muscle Invasive Bladder Cancer After Bacillus Calmette-Guérin Therapy: A Retrospective SEER-Medicare Analysis



We evaluated the real-world healthcare resource utilization (HRU) and costs among patients with high-grade non-muscle invasive bladder cancer (HG-NMIBC) following Bacillus Calmette-Guérin (BCG) therapy.


Patients aged ≥ 65 years diagnosed with HG-NMIBC between 2008 and 2015 who received adequate BCG induction and were identified in the SEER-Medicare database. Those who received intravesical chemotherapy or radical cystectomy within 12 months of the last BCG induction dose, and had ≥ 6 months of data availability after treatment (index date), were included. Annualized HRU and mean medical costs (2020 United States dollars) were estimated and compared between patients with versus without progression. Inverse probability of treatment weighting was used to adjust for differences in baseline characteristics.


Of 986 patients diagnosed with HG-NMIBC who met the inclusion criteria, 257 (26.1%) progressed; the mean ages were similar between patients who did and did not progress (77.6 vs. 77.0 years). The overall population had a mean of 0.96 [standard deviation (SD): 1.18] inpatient admissions, 6.47 (11.40) hospitalization days, 1.38 (2.19) emergency department (ED) visits, and 48.03 (44.97) outpatient visits per patient-year during the study period; total annualized costs per patient post-BCG were $39,102 ($44,244). Patients experiencing progression had significantly higher mean numbers of inpatient admissions [1.61 (SD 1.40) vs. 0.72 (0.99)], hospitalization days [11.77 (14.96) vs. 4.59 (9.29)], ED visits [2.34 (2.92) vs. 1.03 (1.76)], and outpatient visits [65.97 (44.72) vs. 41.63 (43.09)] per patient-year compared with patients without progression (all p < 0.05). Total mean annualized costs per patient after BCG among those who progressed [$65,668 (SD $53,943)] were more than double compared with patients who did not [$29,780 ($36,425)].


Existing treatments for HG-NMIBC after BCG therapy are associated with substantial HRU and medical costs, particularly after progression. Novel treatments and earlier detection are needed to reduce progression rates and associated costs in this difficult-to-treat population.

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Sponsorship for this study and the journal’s Rapid Service Fee were funded by FerGene, Inc.

Medical Writing Assistance

Medical writing assistance was provided by Shelley Batts, PhD, an employee of Analysis Group, Inc. Support for this assistance was funded by FerGene, Inc.


All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Prior Presentations

A synopsis of the current research was accepted in abstract format to the 2020 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) annual research meeting, which took place as a virtual conference on May 18–20, 2020.


Min Yang, Mihaela V. Georgieva, and Iryna Bocharova are employees of Analysis Group, Inc., which has received consulting fees from FerGene for this research. Mohini Vembusubramanian is an employee of Alto Pharmacy and was an employee of Analysis Group, Inc. during the conduct of the study. Kun Qian is an employee of New York University Langone Health and was an employee of Analysis Group, Inc. during the conduct of the study. Amy Guo is an employee of FerGene. Ashish M. Kamat has received honoraria from Merck, BMS, Arquer, MDxHealth, Photocure, Theralase, Medac, Asieris, Abbott Molecular, US Biotest, Ferring, FerGene, Imagin, Eisai, BioClin Therapeutics, Cold Genesys, Roviant, and Sessen Bio; and research funding from Ferring, FerGene, FKD, Merck, BMS, Photocure, and CEC Oncology.

Compliance with Ethics Guidelines

This study received an exemption from institutional board review from the New England Independent Review Board on September 13, 2018, since this is a retrospective analysis of existing de-identified data. This article does not contain any new studies with human participants or animals performed by any of the authors.

Data Availability

The datasets analyzed during the current study are not publicly available, as they are subject to a data use agreement between the National Cancer Institute and Analysis Group, Inc. Information about the data used in this study, including detailed descriptions and the process for obtaining them, is available at

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Correspondence to Min Yang.

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Yang, M., Georgieva, M.V., Bocharova, I. et al. The Impact of Progression on Healthcare Resource Utilization and Costs Among Patients with High-Grade Non-Muscle Invasive Bladder Cancer After Bacillus Calmette-Guérin Therapy: A Retrospective SEER-Medicare Analysis. Adv Ther 38, 1584–1600 (2021).

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  • Bacillus Calmette-Guérin therapy
  • Disease progression
  • Healthcare costs
  • Healthcare resource utilization
  • Non-muscle invasive bladder cancer
  • Real world outcomes