Trimodal Therapy is Inferior to Radical Cystectomy for Muscle-invasive Bladder Cancer using Population-level Data: Is There Evidence in the (Lack of) Details?

2017 ◽  
Vol 72 (4) ◽  
pp. 488-489 ◽  
Author(s):  
Girish S. Kulkarni ◽  
Zachary Klaassen
JAMA Surgery ◽  
2019 ◽  
Vol 154 (8) ◽  
pp. e191629 ◽  
Author(s):  
Stephen B. Williams ◽  
Yong Shan ◽  
Mohamed D. Ray-Zack ◽  
Hogan K. Hudgins ◽  
Usama Jazzar ◽  
...  

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e16021-e16021
Author(s):  
Daniel Phillips ◽  
Tamer Dafashy ◽  
Yong Shan ◽  
Mohamed Danny Ray-Zack ◽  
Hogan K Hudgins ◽  
...  

e16021 Background: Earlier studies on the cost of muscle-invasive bladder cancer treatments lack granularity and are limited to 180 days. The objective of this study is to compare the one-year costs associated with trimodal therapy versus radical cystectomy, accounting for survival and intensity effects on total costs. Methods: This cohort study used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Data analysis was performed from March 5, 2018 through December 4, 2018. A total of 2,963 patients aged 66-85 years diagnosed with clinical stage T2-4a muscle-invasive bladder cancer from January 1, 2002 through December 31, 2011. Total Medicare costs within one year of diagnosis following radical cystectomy versus trimodal therapy were compared using inverse probability of treatment-weighted (IPTW) propensity score models, which included a two-part estimator to account for intrinsic selection bias. Results: Median costs were significantly higher for trimodal therapy than radical cystectomy in 90 days ($83,754 vs. $68,692; median difference $11,805, 95% CI $7,745 to $15,864), 180 days ($187,162 vs. $109,078; median difference $62,370, 95% CI $55,581 to $69,160), and 365 days ($289,142 vs. $148,757; median difference $109,027, 95% CI $98,692 to $119,363), respectively. Outpatient care, radiology, medication expenses and pathology/laboratory costs contributed largely to the higher costs associated with trimodal therapy. On IPTW-adjusted analyses, patients undergoing trimodal therapy had $129,854 (95% CI $115,793-$145,299) higher costs compared with radical cystectomy one year after diagnosis. Conclusions: Compared to radical cystectomy, trimodal therapy was associated with higher costs among patients with muscle-invasive bladder cancer. Extrapolating cost figures resulted in nationwide excess spending of $444 million for trimodal therapy compared with radical cystectomy for patients diagnosed in 2017.


2021 ◽  
Vol 32 (4) ◽  
pp. 164
Author(s):  
StevenK Huang ◽  
Wen-Hsin Tseng ◽  
Chien-Liang Liu ◽  
Jinn-Rung Kuo ◽  
Shun-Hsing Hun ◽  
...  

JAMA Surgery ◽  
2018 ◽  
Vol 153 (10) ◽  
pp. 881 ◽  
Author(s):  
Stephen B. Williams ◽  
Yong Shan ◽  
Usama Jazzar ◽  
Hemalkumar B. Mehta ◽  
Jacques G. Baillargeon ◽  
...  

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e16029-e16029
Author(s):  
Tamer Dafashy ◽  
Daniel Phillips ◽  
Yong Shan ◽  
Hogan K Hudgins ◽  
Usama Jazzar ◽  
...  

e16029 Background: Radical cystectomy is the guideline-recommended treatment for muscle-invasive bladder cancer; however, use of trimodal therapy, which utilizes a combination of surgery, radiation, and chemotherapy, has increased in recent years with conflicting survival outcomes. Methods: Utilizing data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, a total of 2,963 patients aged 66 years or older diagnosed with clinical stage T2-4a bladder cancer from January 1, 2002 to December 31, 2011 were analyzed. Conventional regression, propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to compare radical cystectomy and trimodal therapy for overall and cancer-specific survival, and cost. Results: Patients who underwent TMT had significantly decreased overall (conventional regression: Hazard Ratio (HR) 1.54, 95% Confidence Interval (CI), 1.39-1.71; PSM: HR 1.49, 95% CI 1.31-1.69; IPTW: HR 1.54, 95% CI 1.39-1.71) and cancer-specific (conventional regression: HR 1.51, 95% CI 1.40-1.63; PSM: HR 1.55, 95% CI 1.32-1.83; IPTW: HR 1.51, 95% CI 1.40-1.63) survival. Median total costs were significantly higher with trimodal therapy than with radical cystectomy at 6-month ($171,401 vs. $99,890, p < 0.001). Conclusions: Using population-based data and different analytic methods to control for imbalance between study groups, we found that trimodal therapy was associated with decreased overall and cancer-specific survival at increased costs compared to radical cystectomy.


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