South Central Section of the AUA 2022

SCS AUA 2022: Long Term Cost Comparisons of Radical Cystectomy Versus Trimodal Therapy

( Earlier studies on the cost of muscle-invasive bladder cancer treatments are limited to short-term periods of cost. Our study objective is to compare the 2- and 5-year costs associated with trimodal therapy (TMT) versus radical cystectomy (RC) benchmarked against costs for patients who received no curative treatment.

This cohort study used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. A total of 2,537 patients aged 66-85 years diagnosed with clinical stage T2-4a muscle-invasive bladder cancer from January 1, 2002, through December 31, 2009. Total Medicare costs at 2-and 5-years following TMT versus RC were compared using inverse probability of treatment-weighted (IPTW) propensity score models.

They found compared to patients with no definitive treatments (total median costs at 2 and 5-years ($73,780 vs. $88,275), costs were significantly higher for TMT than RC at 2-years (372,839 vs. 191,363, p<0.001) and 5-years (424,570 vs. 253,651, p<0.001), respectively. On IPTW-adjusted analyses, patients undergoing TMT had significantly higher median costs at 2-years ($132,762:95% CI $112,663-$142,966) and 5-years ($170,919:95% CI $105,711-$143,221) compared with RC. TMT had higher outpatient costs than RC (2-yr: 318,221 vs. 100,900; 5-yr: 367,092 vs. 146,561) with significantly higher costs largely associated with radiology, medications, pathology/laboratory, and other professional services. TMT patients that received ≥23 median fractions vs. RC (with or without chemotherapy) had worse overall survival (HR, 1.22; 95% CI, 1.09-1.38).

In summary, trimodal therapy was associated with higher median costs among patients with muscle-invasive bladder cancer compared to radical cystectomy, largely driven by outpatient expenditures. Reducing costs associated with radiology, medications, pathology/laboratory, and other professional services may improve the value of trimodal therapy. Moreover, appropriate patient selection is critical along with shared decision making to leverage oncologic outcomes and mitigate substantial financial implications.

Presented by: Elias Faran, MD, The University of Texas Medical Branch, Galveston, Texas

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

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