Healthcare Resource Utilisation in Patients with Upper Tract Urothelial Carcinoma

Background: Upper tract urothelial carcinoma (UTUC) is rare, and contemporary data on real-world healthcare resource utilisation and costs are limited. The objective of this study is to describe long-term healthcare resource utilisation among patients with upper tract urothelial carcinoma (UTUC) and to identify clinical and treatment-related drivers of costs. Methods: We conducted a retrospective, population-based cohort study including all patients diagnosed with UTUC between 2019 and 2023 in Region Skåne, Sweden. Patients were identified through the Swedish National Register for Urinary Bladder Cancer (SNRUBC) and linked to regional healthcare databases covering primary, secondary, and tertiary care. The primary outcome was annual direct healthcare cost per patient, derived from Diagnosis-Related Group (DRG) cost data and expressed in 2023 international dollars (Int$). Secondary outcomes were cost patterns and predictors stratified by treatment modality: robot-assisted nephroureterectomy (RANU), open nephroureterectomy (ONU), segmental ureterectomy (SU), and endourological treatment (ET). Results: Among 278 included patients, most were older adults and/or with substantial comorbidity, and over half underwent radical nephroureterectomy. The adjusted mean annual cost was Int$36,870 in 2019, decreasing to Int$30,004 in 2023. In the subgroup treated with ONU, systemic treatment was associated with a higher adjusted cost ratio and in the subgroup operated with SU, female sex was associated with a higher adjusted cost ratio. Comorbidity was a cost driver in the ET subgroup. Conclusions: UTUC care in this Swedish region has become less resource-intensive over a short period. These results can provide a basis for planning UTUC services and highlight targets for cost-conscious, patient-centred optimisation of care.