Trends in 12-Month Mortality and Statutory Health Insurance Costs in Incident Metastatic Bladder Cancer in Germany, 2011–2024

Objective: To describe trends in age- and sex-standardized 12-month overall survival (OS) and inflation-adjusted costs among patients with incident metastatic bladder cancer (mBLC) in anonymized German statutory health insurance claims data from 2011 to 2024.

Methods: Patients with mBLC were identified using ICD-10-GM diagnosis codes: C67 (BLC) and C77–C79 for metastatic disease. Metastatic disease was required to occur within ±3 months of the qualifying BLC diagnosis, with no evidence of mBLC during a 1-year baseline period. Age- and sex-standardized 12-month OS, standardized to the overall German statutory health insurance population, was assessed from the date of incident mBLC (index date). Fourteen annual cohorts were defined according to index date year of each patient (2011–2024). Inflation-adjusted all-cause healthcare costs were measured over the 12-month post-index period for each patient and reported by index-year cohort. Trends in OS and costs were evaluated over time, using 2011 as the reference year.

Results: Annual cohorts were small, with 52 patients in 2011 (mean age: 69.5 years; 15.4% females), a peak of 195 in 2020 (mean age: 69.4 years; 23.6% females), and 56 patients (mean age: 73.0 years; 19.6% females) in 2024. Standardized 12-month OS varied substantially, from 82.4% in patients diagnosed in 2011 to only 62.7% in patients diagnosed in 2020. Over the 14 years, no OS improvement was observed; in 2024, 12-month OS was 70.8%. Costs increased from €32,245 to €43,042 per patient, with a more pronounced rise during the most recent five years and a peak of €49,500 in 2023. Costs excluding the final 4 weeks before death increased from €30,367 to €37,664. Cost shares remained broadly similar over time, with inpatient care continuing to represent the most important cost component.