Incidence of Bladder Cancer, Healthcare Pathways, and Economic Burden: A Real-World Observational Study From the French National Healthcare System Database.

Purpose: To assess the incidence (all lesions) of bladder cancer (BC) in France, describe patient characteristics and healthcare pathways during the first year after diagnosis, and estimate medical costs.

Methods: All adult patients with an initial BC diagnosis (ICD-10 codes: C67, D09.0, D41.4) in 2017 were selected from the French National Healthcare System Database. Patients were classified according to the most invasive surgical procedure they underwent. Treatments included cystectomy, transurethral resection of bladder tumor (TURBT), intravesical therapy, chemotherapy, and radiotherapy. Healthcare pathways were analyzed as sequences and grouped using hierarchical clustering. Medical costs during the first year of the disease were estimated for each cluster.

Results: Out of 24,737 incident BC patients selected, the median age at diagnosis was 72 years, and 80.2% were men. Nearly 20% had received treatment for a cancer other than BC in the previous year. The majority (n = 9501, 38.4%) underwent TURBT only with a mean medical cost of €4435 [95% CI: 4322; 4548]. A total of 3037 patients (12.3%) underwent cystectomy as their initial treatment. The estimated costs for the group receiving intravesical instillations following a single TURBT (€6129 [5994; 6264]) were lower than those for the group with repeated TURBT (€9357 [9086; 9628]). Costs for patients who received systemic treatment after cystectomy were the highest at €25,636 [24,519; 26,752].

Conclusion: Our study estimates the incidence of BC in France, describes healthcare pathways at the national level, and analyses the associated economic burden.