The Financial Burden of Guideline-recommended Cancer Medications for Metastatic Urothelial Carcinoma

Roberto Contieri, Alberto Martini, Laura S. Mertens, Patrizia Giannatempo, Rodolfo Hurle, J. Alfred Witjes, Maria J. Ribal, Bas W. G. van Rhijn, Bernard Malavaud

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)


Bladder cancer is a significant global health concern owing to its prevalence, negative impact on quality of life, and high treatment costs. Treatment for metastatic urothelial carcinoma (mUC) traditionally relies on platinum-based chemotherapy regimens. However, clinical trial results have led to the approval of immune checkpoint inhibitors (ICIs) as viable treatment options. We assessed the escalating costs and economic viability of mUC treatment guidelines in Europe. We used a pragmatic approach that involved: (1) collection of the costs of the recommended medications in the five most populous European countries; (2) conversion of the costs into international dollars to account for differences in purchasing power parity among countries; (3) evaluation of the cost trends over time; and (4) comparison of the medication costs to World Health Organization thresholds. Introduction of ICIs in European guidelines substantially increased the cost of medications for mUC. Intriguingly, important differences across European countries emerged: the annual cost of medications was twofold higher in Italy than in France and the UK. Despite limitations, our study sheds light on the escalating costs and economic challenges of mUC treatment, and highlights the need for assessments of sustainable and cost-effective management approaches. Patient summary: We looked at the costs of treatments for metastatic bladder cancer and found that costs have been rising over time, especially with the introduction of new immune therapies, with notable differences among European countries. While these new treatments improve patient outcomes, they also come with a high price tag, which could strain health care budgets. Our results suggest that cost-effectiveness studies will be essential in determining the best and most sustainable treatment strategies in the future.
Original languageEnglish
JournalEuropean urology focus
Early online date2024
Publication statusE-pub ahead of print - 2024


  • Cost effectiveness
  • Immunotherapy
  • Metastatic urothelial carcinoma

Cite this