Abstract
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.
| Original language | English (US) |
|---|---|
| Journal | JAMA Surgery |
| DOIs | |
| State | Published - Jan 1 2019 |
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ASJC Scopus subject areas
- Surgery
Cite this
Comparison of Costs of Radical Cystectomy vs Trimodal Therapy for Patients with Localized Muscle-Invasive Bladder Cancer. / Williams, Stephen B.; Shan, Yong; Ray-Zack, Mohamed; Hudgins, Hogan K.; Jazzar, Usama; Tyler, Douglas S.; Freedland, Stephen J.; Swanson, Todd A.; Baillargeon, Jacques G.; Hu, Jim C.; Kaul, Sapna; Kamat, Ashish M.; Gore, John L.; Mehta, Hemalkumar.
In: JAMA Surgery, 01.01.2019.Research output: Contribution to journal › Article
}
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
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
PY - 2019/1/1
Y1 - 2019/1/1
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
JO - JAMA Surgery
JF - JAMA Surgery
SN - 2168-6254
ER -