GU Cancers 2019 | Evaluation of costs associated with AEs in urothelial cancer patients

We all have patients who respond very well to checkpoint inhibitors or chemotherapy, one after the other. But many patients may not respond. And many patients may have side effects. So we’re very interested to evaluate the financial burden of the healthcare system in patients who have metastatic urothelial cancer. And receive either chemotherapy or checkpoint inhibitor immunotherapy. And try to quantify, evaluate this financial burden in the healthcare system by trying to measure how much cost is related to the management of adverse events that are related to its therapy, chemotherapy, immunotherapy.

So we embarked on this project in collaboration with a large team that are including experts in financial aspects of healthcare. As well as myself on the clinical research side. And we’re trying to come up with a good measurement of this cost and healthcare utilization are related to adverse event management in patients with metastatic urothelial cancer, who got chemotherapy or immunotherapy.

Most patients, 94%, got chemotherapy. And only 6% had immunotherapy, and this is related to the notion that most of our data were from previous years. Where immune support inhibitors were not that common yet, so we don’t have updated data as of today. And because of this data gap in time, most of the patients had chemotherapy and only a few had immunotherapy.

What we saw was, that if someone had an adverse event, the cost in the healthcare utilization were much higher in patients who did have an adverse event or a severe adverse event, compared to the patients who did not have adverse events. And we focused particularly on common adverse events with chemotherapy, like sepsis, dehydration, acute kidney injury. Or side effects with immunotherapy like hepatitis, colitis, pneumonitis, adrenal insufficiency. And we look at each particular adverse event and the impact that each adverse event has in the healthcare system And also in healthcare utilization with emergency room visits, inpatient hospitalization and out-patient visits.

And it’s interesting that we noted that the driver, the major driver of that cost, is related to inpatient hospitalizations, admissions to the hospital. And I think it’s interesting because if we can educate the providers and the patients for early recognition and proper early management of adverse events, we would potentially have an impact of how to have better outcomes in terms of adverse event management. And hopefully less stress and less impact and less burden of the healthcare system. So early recognition of the adverse event could potentially have better results.

Now we’re going to move this research a step further, and we’re trying to get some more data, comparing each individual side effect. But so far, what we show was a significant difference between the presence and the absence of select adverse events and severe select adverse events. We are going to inform of course, future research projects based on this data. Many attendees ask whether we can compare chemotherapy to immunotherapy in that regard? We did not do this comparison for this study, but definitely this hypothesis generating data, hopefully will be submitted for publication soon.

And the goal here is to generate more discussion in the community about the economical financial aspect of healthcare. Value based care, outcome research and cost-effective in studies. So we’re very very happy that these discussions have started because all together we can have some better dialogue about how to define value-based care. And this I think goes one step closer to that direction.