BACKGROUND AND OBJECTIVE: Bladder cancer (BCa) imposes a substantial economic burden on health care systems and patients. Understanding these financial implications is crucial for effective resource allocation and optimization of treatment cost effectiveness. Here, we aim to systematically review and analyze the financial burden of BCa from the health care and patient perspectives. METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-compliant systematic review was conducted, searching PubMed/Medline, Embase, and public sources for studies evaluating the financial impact of BCa, encompassing costs, cost effectiveness, and financial toxicity (FT). KEY FINDINGS AND LIMITATIONS: Non-muscle-invasive BCa (NMIBC) incurs significant costs for surveillance and treatment, with costs exceeding $200 000 after 5 yr for high-risk NMIBC patients progressing after bacillus Calmette-Guerin (BCG) treatment (including inpatient, outpatient, and physician service expenses). Muscle-invasive BCa generates substantial costs from radical cystectomy (RC) and neoadjuvant chemotherapy, averaging $30 000-40 000 from surgical costs of RC, with additional expenses in case of complications. Trimodal therapy has higher costs (1-yr management cost >$200 000) than RC because of higher outpatient, radiology, and medication costs. Metastatic BCa incurs the highest financial burden, with systemic therapy costs ranging from $40 000 to over $100 000 per five-cycle course, increasing further with combination therapies (ie, enfortumab vedotin and pembrolizumab), treatment-related toxicity, and supportive care. FT is particularly prevalent among younger, less educated, and minority populations. CONCLUSIONS AND CLINICAL IMPLICATIONS: BCa treatment, particularly in advanced stages, imposes a substantial economic burden. Innovations in care, while improving oncologic outcomes, necessitate detailed cost-effectiveness assessments. Addressing these economic challenges is essential for optimizing BCa management, targeting patients at a higher risk of FT, and improving patient quality of life.

Dana Farber Cancer Institute Boston MA USA

Department of Experimental Oncology Unit of Urology URI IRCCS Ospedale San Raffaele Milan Italy

Department of Experimental Oncology Unit of Urology URI IRCCS Ospedale San Raffaele Milan Italy; Vita Salute San Raffaele University Milan Italy

Department of Genitourinary Oncology Moffitt Cancer Center Tampa FL USA

Department of Urologic Sciences University of British Columbia Vancouver BC Canada

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria; Department of Urology University of Texas Southwestern Dallas TX USA; Karl Landsteiner Institute of Urology and Andrology Vienna Austria; Department of Urology Weill Cornell Medical College New York NY USA; Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Urology University of Texas MD Anderson Cancer Center Houston TX USA

Department of Urology University of Washington School of Medicine Seattle WA USA

Scott Department of Urology Dan L Duncan Comprehensive Cancer Center Baylor College of Medicine Houston TX USA

Sorbonne University GRC 5 Predictive Onco Uro AP HP Urology Pitie Salpetriere Hospital F 75013 PARIS France

Taussig Cancer Institute Cleveland Clinic Cleveland OH USA

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