1. Comparing Costs of Radical Versus Partial Cystectomy for Patients Diagnosed With Localized Muscle-Invasive Bladder Cancer: Understanding the Value of Surgical Care.
- Author
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Bagheri I, Shan Y, Klaassen Z, Kamat AM, Konety B, Mehta HB, Baillargeon JG, Srinivas S, Tyler DS, Swanson TA, Kaul S, Hollenbeck BK, and Williams SB
- Subjects
- Aged, Aged, 80 and over, Clinical Decision-Making, Cystectomy methods, Cystectomy statistics & numerical data, Female, Humans, Kaplan-Meier Estimate, Male, Medicare economics, Medicare statistics & numerical data, Neoplasm Invasiveness pathology, Propensity Score, SEER Program statistics & numerical data, Treatment Outcome, United States epidemiology, Urinary Bladder pathology, Urinary Bladder surgery, Urinary Bladder Neoplasms economics, Urinary Bladder Neoplasms mortality, Urinary Bladder Neoplasms pathology, Costs and Cost Analysis statistics & numerical data, Cystectomy economics, Urinary Bladder Neoplasms surgery
- Abstract
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., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2021
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