Healthcare utilization and expenditure burden in bladder cancer: A nationally representative analysis (MEPS 2015–2022).

Abstract

645 Background: Bladder Cancer (BCa) is recognized as a high-cost malignancy, largely from chronic disease course, recurrence, and intensive follow-up. However, data on healthcare utilization (HCU) and expenditures (exp), including out-of-pocket (OOP) costs, remain limited. We compared HCU and costs across BCa, other cancers, and non-cancer groups. Methods: A repeated cross-sectional study using the Medical Expenditure Panel Survey (2015–2022) categorized respondents as BCa, non-BCa cancers (prostate, colorectal, lung, melanoma, lymphoma, breast, gynecologic), or no cancer history. Outcomes included annual healthcare utilization (HCU)—emergency, outpatient, inpatient, and prescription visits per person per year, and expenditures (total and out-of-pocket), inflation-adjusted to 2020 USD. Survey-weighted regression estimated incidence rate ratios (IRRs, 95% CIs), adjusting for demographic, sociodemographic, functional, and clinical covariates. Results: Among 165,665 respondent-years (85,194 individuals; mean age 55.7 years), 0.2% had bladder cancer (BCa), 4.5% other cancers, and 95.3% no cancer. BCa patients had the highest healthcare utilization (38.9 ± 33.3 physician interactions; 0.44 ± 0.86 emergency visits per year), followed by non-BCa cancers (38.2 ± 36.6) and no-cancer respondents (14.8 ± 26.3; p<0.001). In adjusted analyses, overall utilization was similar for BCa and other cancers (IRR 0.98, 95% CI 0.83–1.16) but lower for those without cancer (IRR 0.81, 0.69–0.97). Non-BCa cancers had fewer emergency (IRR 0.68, 0.49–0.94) and inpatient visits (IRR 0.71, 0.53–0.95), while outpatient and prescription use were comparable. Mean annual total expenditures were $15,537 (BCa), $16,305 (non-BCa), and $4,201 (no cancer; p<0.001); adjusted total spending was similar for BCa and other cancers (IRR 0.98, 0.69–1.30) but lower for no cancer (IRR 0.64, 0.53–0.77). Out-of-pocket costs averaged $1,320 (BCa), $1,518 (non-BCa), and $509 (no cancer; p<0.001). Conclusions: BCa patients had greater emergency and inpatient utilization than both non-cancer and other cancer respondents. Interestingly, despite higher service use, their total and OOP expenditures were comparable to those of other malignancies. Healthcare utilization and expenditure ratios (ref: bladder cancer). Outcome Category Outcome No History of Cancer, IRR (95% CI) Non-Bladder Cancer, IRR (95% CI) Utilization Total interactions 0.81 (0.69–0.97)* 0.98 (0.83–1.16) Emergency visits 0.52 (0.38–0.72)* 0.68 (0.49–0.94)* Outpatient visits 0.69 (0.59–0.81)* 0.92 (0.78–1.08) Inpatient visits 0.49 (0.37–0.65)* 0.71 (0.53–0.95)* Prescriptions filled 0.90 (0.74–1.09) 1.01 (0.83–1.23) Expenditures Total healthcare 0.64 (0.53–0.77)* 0.98 (0.69–1.30) Out-of-pocket 0.93 (0.70–1.23) 1.14 (0.85–1.53) *p<0.05.