We examined the trends in use of imaging as well as costs associated with imaging within 12 months from diagnosis of bladder cancer. A total of 36,855 patients aged 66 years or older diagnosed with clinical stage TI-IV, N0M0 bladder cancer from 2004 to 2011 were analyzed. In total, 24,240 (65.8%) patients received one of these three imaging modalities within 12 months after bladder cancer diagnosis: 1,291 (3.5%) PET/CT, 1,495 (4.1%) MRI, and 21,454 (58.2%) CT. Independent of clinical stage, there was marked increase in use of PET/CT throughout the study period (2011 v 2004: OR 17.55, 95% CI = 10.14-30.38, P<0.001). We also observed a greater use of PET/CT among female patients, residents in West region, patients diagnosed with hydronephrosis or high grade tumor, and patients who underwent surgery, chemotherapy, or radiation therapy.
The mean incremental cost of PET/CT vs. CT and MRI was $1,040 and $612 (in 2016 dollars), respectively. The estimated national excess in health care costs for PET/CT imaging compared to less costlier conventional CT and MRI techniques was $11.6 million.
In summary, we assessed trends in use of PET/CT, MRI, and CT among bladder cancer patients. Our study revealed a significant shift in the type of imaging modality performed during the study period. Specifically, we observed marked 16-fold increased use of PET/CT regardless of clinical stage. This rapid adoption of PET/CT translated into excess national spending of approximately $11 million. These findings have important implications regarding health policy decision-making and the need for improved value-based bladder cancer care.
Written by: Stephen B. Williams, MD, The University of Texas Medical Branch
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