Long term cost comparisons of radical cystectomy versus trimodal therapy for muscle-invasive bladder cancer

Vishnukamal Golla, Yong Shan, Elias J. Farran, Courtney A. Stewart, Kevin Vu, Alexander Yu, Ali Raza Khaki, Divya Ahuja Parikh, Todd A. Swanson, Kirk A. Keegan, Ashish M. Kamat, Douglas S. Tyler, Stephen J. Freedland, Stephen B. Williams

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Earlier studies on the cost of muscle-invasive bladder cancer treatments are limited to short-term costs of care. We determined the 2- and 5-year costs associated with trimodal therapy (TMT) vs. radical cystectomy (RC). Methods: We performed a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Total Medicare costs at 2 and 5 years following RC vs. TMT were compared using inverse probability of treatment-weighted propensity score models. Results: A total of 2,537 patients aged 66 to 85 years were diagnosed with clinical stage T2-4a muscle-invasive bladder cancer. Total median costs for patients that received no definitive treatment(s) were $73,780 and $88,275 at 2-and 5-years. Costs were significantly higher for TMT than RC at 2-years ($372,839 vs. $191,363, Median Difference $127,815, Hodges-Lehmann Estimate (H-L) 95% Confidence Interval (CI), $112,663–$142,966) and 5-years ($424,570 vs. $253,651, Median Difference $124,466, H-L 95% CI, $105,711–$143,221). TMT had higher outpatient costs than RC (2-years: $318,221 vs. $100,900; 5-years: $367,092 vs. $146,561) with significantly higher costs with radiology, medications, pathology/laboratory, and other professional services. RC had higher inpatient costs than TMT (2-years: $62,240 vs. $33,631, Median Difference $-29,174, H-L 95% CI, $-32,364–$-25,984; 5-years: $75,499 vs. $45,223, Median Difference $-29,843, H-L 95% CI, $-33,905–$-25,781). Conclusions and Relevance: The excess spending associated with trimodal therapy vs. radical cystectomy was largely driven by outpatient expenditures. The relatively high long-term trimodal therapy costs are prime targets for cost containment strategies to optimize future value-based care.

Original languageEnglish (US)
Pages (from-to)273.e1-273.e9
JournalUrologic Oncology: Seminars and Original Investigations
Volume40
Issue number6
DOIs
StatePublished - Jun 2022

Keywords

  • Bladder cancer
  • Costs
  • Radiation
  • Radical cystectomy
  • SEER
  • Trimodal therapy

ASJC Scopus subject areas

  • Oncology
  • Urology

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