(UroToday.com) Perioperative healthcare costs for patients undergoing radical cystectomy for bladder cancer has been shown to vary by robotic and open surgical approaches and type of diversion. A key knowledge gap, however, is the long-term economic burden for this highly expensive urologic malignancy. In this context, they elucidated long-term healthcare costs amongst patients undergoing radical cystectomy for the treatment of bladder cancer.
From a population-based cohort of privately insured patients, they identified individuals who underwent open or robotic radical cystectomy with either ileal conduit or neobladder diversion from 2010 to 2015 using the MarketScan database. The total healthcare costs from all clinical, emergency room visits, initial total hospital cost, and subsequent readmissions were calculated during a 5-year period following radical cystectomy. They used bivariate and multivariable analyses to identify surgical and clinical covariates associated with higher long-term health care costs.
Overall, they identified 2,961 patients diagnosed with bladder cancer who underwent radical cystectomy from 2010 to 2015. Most patients underwent open radical cystectomy with ileal conduit (56.7%) with 22.7%, 14.7% and 3.2% undergoing open radical cystectomy with neobladder, robotic radical cystectomy with ileal conduit, and robotic radical cystectomy with neobladder, respectively. The median of total healthcare costs at 5-years were modestly higher for open radical cystectomy with neobladder ($103,356; IQR: $64,296 – $173,249) relative to open radical cystectomy with ileal conduit ($93,533; IQR: $54,732 – $163,744), robotic radical cystectomy with ileal conduit ($93,350; IQR: $61,681 – $150,053) and robotic radical cystectomy with neobladder ($88,216; IQR: $57,147 – $147,866; Overall p = 0.01). On multivariable analysis, patients with higher Elixhauser comorbidities and those who underwent open radical cystectomy with neobladder were associated with higher total health care costs at 5-years (both p < 0.01) than those who underwent minimally invasive radical cystectomy.
In summary, bladder cancer patients with higher comorbidities who underwent open radical cystectomy with neobladder had higher long-term healthcare costs; however, minimally invasive surgical approaches were not associated with higher healthcare costs at 5 years. Increased research is needed to develop interventions to reduce the high costs associated with treatment of bladder cancer. Moreover, these results, as with other prior work, are derived from a pre-immunotherapy era where further substantial costs of care remain to be determined for the most costly cancer: bladder cancer.
Presented by: Xavier Glover, MD, University of Colorado School of Medicine, Boulder, CO.
Written by: Stephen B. Williams, MD, MBA, MS @SWilliams_MD on Twitter during the South Central Section American Urological Association Annual Meeting, September 6-10, 2022, Coronado, CA