TY - JOUR
T1 - Comparison of Costs of Radical Cystectomy vs Trimodal Therapy for Patients with Localized Muscle-Invasive Bladder Cancer
AU - Williams, Stephen B.
AU - Shan, Yong
AU - Ray-Zack, Mohamed D.
AU - Hudgins, Hogan K.
AU - Jazzar, Usama
AU - Tyler, Douglas S.
AU - Freedland, Stephen J.
AU - Swanson, Todd A.
AU - Baillargeon, Jacques G.
AU - Hu, Jim C.
AU - Kaul, Sapna
AU - Kamat, Ashish M.
AU - Gore, John L.
AU - Mehta, Hemalkumar
N1 - Funding Information:
the support of a US Department of Defense Peer Reviewed Cancer Research Program Career Development Award (W81XWH1710576), the Herzog Foundation, the Institute for Translational Sciences at the University of Texas Medical Branch, and a Clinical and Translational Science Award (grants UL1 TR001439 and 1TL1TR00144003) from the National Center for Advancing Translational Sciences (Dr Ray-Zack).
Funding Information:
Additional Contributions: We thank the Applied Research Program of the National Cancer Institute; the Office of Research, Development and Information of the Centers for Medicaid Services; Information Management Services, Inc; and the Surveillance, Epidemiology, and End Results (SEER) program tumor registries for their work in creating the SEER database. We thank Yong-Fang Kuo, PhD, and Karl Anderson, PhD, University of Texas Medical Branch at Galveston, for their expert review in preparation of the manuscript for submission.
Funding Information:
reported grants from the US Department of Defense outside the submitted work. Dr Baillargeon reported personal fees from AbbVie, Endo Pharmaceuticals, GlaxoSmithKline, and Auxilium Pharmaceuticals outside the submitted work. Dr Kamat received grant support from CEC Oncology; received personal fees from Photocure, BMS, Merck, FKD, Arquer, Asieris, Abbott Molecular, MDxHealth, Theralase, Medac, US Biotest, Ferring, Eisai, and BioClin Therapeutics; served as an advisory board member and consultant for Photocure, BMS, Merck, FKD, Arquer, Asieris, Abbott Molecular, MDxHealth, Theralase, Medac, US Biotest, Ferring, Imegin, Eisai, BioClin, Therapeutics, Cold Genesys, Roviant, and Sessen Bio; holds a patent to CyPRIT (Cytokine Predictors of Response to Intravesical Therapy); and serves on the editorial board of European Urology Oncology. No other disclosures were reported.
Publisher Copyright:
© 2019 American Medical Association. All rights reserved.
PY - 2019/8
Y1 - 2019/8
N2 - Importance: Earlier studies on the cost of muscle-invasive bladder cancer treatments lack granularity and are limited to 180 days. Objective: To compare the 1-year costs associated with trimodal therapy vs radical cystectomy, accounting for survival and intensity effects on total costs. Design, Setting, and Participants: This population-based cohort study used the US Surveillance, Epidemiology, and End Results-Medicare database and included 2963 patients aged 66 to 85 years who had received a diagnosis of clinical stage T2 to T4a muscle-invasive bladder cancer from January 1, 2002, through December 31, 2011. The data analysis was performed from March 5, 2018, through December 4, 2018. Main Outcomes and Measures: Total Medicare costs within 1 year of diagnosis following radical cystectomy vs trimodal therapy were compared using inverse probability of treatment-weighted propensity score models that included a 2-part estimator to account for intrinsic selection bias. Results: Of 2963 participants, 1030 (34.8%) were women, 2591 (87.4%) were white, 129 (4.4%) were African American, and 98 (3.3%) were Hispanic. Median costs were significantly higher for trimodal therapy than radical cystectomy in 90 days (83754 vs 68692; median difference, 11805; 95% CI, 7745-15864), 180 days (187162 vs 109078; median difference, 62370; 95% CI, 55581-69160), and 365 days (289142 vs 148757; median difference, 109027; 95% CI, 98692-119363), respectively. Outpatient care, radiology, medication expenses, and pathology/laboratory costs contributed largely to the higher costs associated with trimodal therapy. On inverse probability of treatment-weighted adjusted analyses, patients undergoing trimodal therapy had 136935 (95% CI, 122131-152115) higher mean costs compared with radical cystectomy 1 year after diagnosis. Conclusions and Relevance: Compared with radical cystectomy, trimodal therapy was associated with higher costs among patients with muscle-invasive bladder cancer. The differences in costs were largely attributed to medication and radiology expenses associated with trimodal therapy. Extrapolating cost figures resulted in a nationwide excess spending of 468 million for trimodal therapy compared with radical cystectomy for patients who received a diagnosis of bladder cancer in 2017.
AB - Importance: Earlier studies on the cost of muscle-invasive bladder cancer treatments lack granularity and are limited to 180 days. Objective: To compare the 1-year costs associated with trimodal therapy vs radical cystectomy, accounting for survival and intensity effects on total costs. Design, Setting, and Participants: This population-based cohort study used the US Surveillance, Epidemiology, and End Results-Medicare database and included 2963 patients aged 66 to 85 years who had received a diagnosis of clinical stage T2 to T4a muscle-invasive bladder cancer from January 1, 2002, through December 31, 2011. The data analysis was performed from March 5, 2018, through December 4, 2018. Main Outcomes and Measures: Total Medicare costs within 1 year of diagnosis following radical cystectomy vs trimodal therapy were compared using inverse probability of treatment-weighted propensity score models that included a 2-part estimator to account for intrinsic selection bias. Results: Of 2963 participants, 1030 (34.8%) were women, 2591 (87.4%) were white, 129 (4.4%) were African American, and 98 (3.3%) were Hispanic. Median costs were significantly higher for trimodal therapy than radical cystectomy in 90 days (83754 vs 68692; median difference, 11805; 95% CI, 7745-15864), 180 days (187162 vs 109078; median difference, 62370; 95% CI, 55581-69160), and 365 days (289142 vs 148757; median difference, 109027; 95% CI, 98692-119363), respectively. Outpatient care, radiology, medication expenses, and pathology/laboratory costs contributed largely to the higher costs associated with trimodal therapy. On inverse probability of treatment-weighted adjusted analyses, patients undergoing trimodal therapy had 136935 (95% CI, 122131-152115) higher mean costs compared with radical cystectomy 1 year after diagnosis. Conclusions and Relevance: Compared with radical cystectomy, trimodal therapy was associated with higher costs among patients with muscle-invasive bladder cancer. The differences in costs were largely attributed to medication and radiology expenses associated with trimodal therapy. Extrapolating cost figures resulted in a nationwide excess spending of 468 million for trimodal therapy compared with radical cystectomy for patients who received a diagnosis of bladder cancer in 2017.
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U2 - 10.1001/jamasurg.2019.1629
DO - 10.1001/jamasurg.2019.1629
M3 - Article
C2 - 31166593
AN - SCOPUS:85066922982
SN - 2168-6254
VL - 154
JO - JAMA Surgery
JF - JAMA Surgery
IS - 8
M1 - e191629
ER -