Comparing Costs of Radical Versus Partial Cystectomy for Patients Diagnosed With Localized Muscle-Invasive Bladder Cancer: Understanding the Value of Surgical Care - 31/12/20

Doi : 10.1016/j.urology.2020.08.058

Iyla Bagheri ¹, Yong Shan ¹, Zachary Klaassen ², Ashish M. Kamat ³, Badrineth Konety ⁴, Hemalkumar B. Mehta ⁵, Jacques G. Baillargeon ⁶, Sunay Srinivas ¹, Douglas S. Tyler ⁷, Todd A. Swanson ⁸, Sapna Kaul ⁹, Brent K. Hollenbeck ¹⁰, Stephen B. Williams ^1,^⁎
¹ Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, TX
² Department of Surgery, Section of Urology, Medical College of Georgia, Augusta University, Augusta, GA
³ Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
⁴ Department of Urology, University of Minnesota, Minneapolis, MN
⁵ Department of Epidemiology, Johns Hopkins University, Baltimore, MD
⁶ Department of Medicine, Division of Epidemiology, Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX
⁷ Department of Surgery, The University of Texas Medical Branch, Galveston, TX
⁸ Department of Radiation Oncology, The University of Texas Medical Branch, Galveston, TX
⁹ Department of Preventive Medicine and Community Health, The University of Texas Medical Branch at Galveston, Galveston, TX
¹⁰ Department of Urology, University of Michigan, Ann Arbor, MI

^⁎Address correspondence to: Stephen B. Williams, M.D., M.S., The University of Texas Medical Branch, Division of Urology, 301 University Blvd, Galveston, TX 77555.The University of Texas Medical BranchDivision of Urology301 University BlvdGalvestonTX77555

Résumé

Objective

To compare costs associated with radical versus partial cystectomy. Prior studies noted substantial costs associated with radical cystectomy, however, they lack surgical comparison to partial cystectomy.

Methods

A total of 2305 patients aged 66-85 years diagnosed with clinical stage T2-4a muscle-invasive bladder cancer from January 1, 2002 to December 31, 2011 were included. Total Medicare costs within 1 year of diagnosis following radical versus partial cystectomy were compared using inverse probability of treatment-weighted propensity score models. Cox regression and competing risks analysis were used to determine overall and cancer-specific survival, respectively.

Results

Median total costs were not significantly different for radical than partial cystectomy in 90 days ($73,907 vs $65,721; median difference $16,796, 95% CI $10,038-$23,558), 180 days ($113,288 vs $82,840; median difference $36,369, 95% CI $25,744-$47,392), and 365 days ($143,831 vs $107,359; median difference $34,628, 95% CI $17,819-$53,558), respectively. Hospitalization, surgery, pathology/laboratory, pharmacy, and skilled nursing facility costs contributed largely to costs associated with either treatment. Patients who underwent partial cystectomy had similar overall survival but had worse cancer-specific survival (Hazard Ratio 1.45, 95% Confidence Interval, 1.34-1.58, P < .001) than patients who underwent radical cystectomy.

Conclusion

While treatments for bladder cancer are associated with substantial costs, we showed radical cystectomy had comparable total costs when compared to partial cystectomy among patients with muscle-invasive bladder cancer. However, partial cystectomy resulted in worse cancer-specific survival further supporting radical cystectomy as a high-value surgical procedure for muscle-invasive bladder cancer.

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