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Tuo Z, Zhang Y, Wang J, Zhou H, Lu Y, Wang X, Yang C, Yu D, Bi L. Three-port approach vs standard laparoscopic radical cystectomy with an ileal conduit: a single-centre retrospective study. BMC Urol 2021; 21:159. [PMID: 34781963 PMCID: PMC8591944 DOI: 10.1186/s12894-021-00920-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the effect of the three-port approach and conventional five-port laparoscopic radical cystectomy (LRC) with an ileal conduit. METHODS Eighty-four patients, who were diagnosed with high-risk non-muscle-invasive and muscle-invasive bladder carcinoma and underwent LRC with an ileal conduit between January 2018 and April 2020, were retrospectively evaluated. Thirty and fifty-four patients respectively underwent the three-port approach and five-port LRC. Clinical characteristics, pathological data, perioperative outcomes, and follow-up data were analysed. RESULTS There were no differences in perioperatively surgical outcome, including pathology type, prostate adenocarcinoma incidence, tumour staging, and postoperative creatinine levels between the two groups. The operative time (271.3 ± 24.03 vs. 279.57 ± 48.47 min, P = 0.299), estimated blood loss (65 vs. 90 mL, P = 0.352), time to passage of flatus (8 vs. 10 days, P = 0.084), and duration of hospitalisation post-surgery (11 vs. 12 days, P = 0.922) were no clear difference between both groups. Compared with the five-port group, the three-port LRC group was related to lower inpatient costs (12 453 vs. 14 134 $, P = 0.021). Our follow-up results indicated that the rate of postoperative complications, 90-day mortality, and the oncological outcome did not show meaningful differences between these two groups. CONCLUSIONS Three-port LRC with an ileal conduit is technically safe and feasible for the treatment of bladder cancer. On comparing the three-port LRC with the five-port LRC, our technique does not increase the rate of short-term and long-term complications and tumour recurrence, but the treatment costs of the former were reduced.
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Affiliation(s)
- Zhouting Tuo
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China
| | - Ying Zhang
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China
| | - Jinyou Wang
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China
| | - Huan Zhou
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China
| | - Youlu Lu
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China
| | - Xin Wang
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China
| | - Chao Yang
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China
| | - Dexin Yu
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China
| | - Liangkuan Bi
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China.
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Degener S, Dreger NM, Gödde D, Dotse J, Roth S, Heppner HJ, Lefering R, von Rundstedt FC. The natural history of muscle-invasive bladder cancer in geriatric patients undergoing transurethral resection only: Outcome and cost. Urol Oncol 2020; 39:300.e7-300.e13. [PMID: 33308977 DOI: 10.1016/j.urolonc.2020.11.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/16/2020] [Accepted: 11/21/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Bladder cancer is predominant in the elderly. Up to 70% of geriatric patients with muscle-invasive bladder cancer do not receive curative treatment. We analyzed the outcome of patients managed only by transurethral resection of bladder tumor (TURBT) without chemo- or radio-therapy, and performed a cost analysis of the cumulative inpatient interventions throughout the course of the disease. METHODS From 2010 to 2016 81 patients ≥75 years with de novo muscle-invasive bladder cancer who were not eligible for curative treatment options were analyzed retrospectively. All patients were treated only with TURBT. Overall survival (OS) was measured by Kaplan-Meier plots (log-rank test) and clinical parameters predicting OS by a multivariate analysis. The cost analysis was based on actual billing from the hospital provider and referenced standardized pricing in Germany for bladder cancer treatment. RESULTS The median age was 83 years. The OS was 11 months, the 1-year OS was 42%. In the multivariate model Charlson Comorbidity Index <8 (P = 0.016), tumor size ≤3 cm (P = 0.011), complete (T0) tumor resection (P = 0.003), normal C-reactive protein level (P = 0.010), and initial elective surgery (P = 0.035) were shown to be independent predictors of longer OS in palliative TURBT regimes. Median treatment cost for the TURBT regimen was $16,175 vs. $16,467 for a salvage radical cystectomy in this cohort. CONCLUSIONS In a TURBT-only concept elective surgery, tumor size, Charlson Comorbidity Index, C-reactive protein level and complete TURBT are independent predictors of OS. The treatment-related cumulative cost appears to be higher in patients not managed by cystectomy.
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Affiliation(s)
- Stephan Degener
- Department of Urology, Helios University Hospital Wuppertal, University of Witten/Herdecke, Germany.
| | - Nici Markus Dreger
- Department of Urology, Helios University Hospital Wuppertal, University of Witten/Herdecke, Germany
| | - Daniel Gödde
- Department of Pathology, Helios University Hospital Wuppertal, University of Witten/Herdecke, Germany
| | - Judith Dotse
- Department of Urology, Helios University Hospital Wuppertal, University of Witten/Herdecke, Germany
| | - Stephan Roth
- Department of Urology, Helios University Hospital Wuppertal, University of Witten/Herdecke, Germany
| | - Hans Jürgen Heppner
- Department of Geriatrics, Helios Hospital Schwelm, University of Witten/Herdecke, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine, IFOM, University of Witten/Herdecke, Cologne, Germany
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Huynh MJ, Wang Y, Chang SL, Tully KH, Chung BI, Wright JL, Mossanen M. The cost of obesity in radical cystectomy. Urol Oncol 2020; 38:932.e9-932.e14. [PMID: 32620482 DOI: 10.1016/j.urolonc.2020.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/13/2020] [Accepted: 05/11/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The prevalence of obesity is on the rise in the Unites States, and obesity has been associated with increased complications and costs in a variety of complex surgeries. However, the contribution of obesity to the overall costs of radical cystectomy has not been studied in detail using contemporary data. Our objective is to assess the variation in healthcare costs due to obesity on the index hospitalization for radical cystectomy in the United States between 2003 and 2015. MATERIALS AND METHODS This was a retrospective cohort study, using the Premier Healthcare Database, of 1,242 patients who underwent radical cystectomy and were either overweight (25 ≤ body mass index [BMI] < 30), obese (30 ≤ BMI < 40), or morbidly obese (BMI ≥ 40). The primary outcome costs of the index hospitalization for each BMI category. Multivariable median regression was used to identify drivers of increased costs. RESULTS The cost of the index hospitalization for cystectomy was $24,596 (95% confidence interval [CI], $22,599-$26,592) for overweight patients. The costs for obese and morbidly obese patients were $2,158 (95% CI, -$80 to $4,395, P = 0.059) and $5,308 (95% CI, $2,652-$7,964, P < 0.001) higher compared to overweight patients, respectively. After adjustment for operative time or length of stay in the multivariable models, there were no longer any differences in cost. Operative time was prolonged as BMI increased (median operative time for overweight, obese, and morbidly obese: 346, 391, and 420 minutes, respectively P = 0.0001). Median length of stay was 1 day shorter for overweight vs. morbidly obese patients (P = 0.0030), with each additional day costing $1,738 (95% CI, $1,654 to $1,821, P < 0.0001) on multivariable analysis. CONCLUSIONS The cost of radical cystectomy is greater for obese and morbidly obese patients compared to overweight patients. The increased financial cost is driven by increased operative times and longer length of stay.
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Affiliation(s)
- Melissa J Huynh
- Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Ye Wang
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - Steven L Chang
- Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
| | - Karl H Tully
- Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA; Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | | | - Jonathan L Wright
- Department of Urology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Matthew Mossanen
- Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA.
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Tandogdu Z, Lewis R, Duncan A, Penegar S, McDonald A, Vale L, Shen J, Kelly JD, Pickard R, N Dow J, Ramsay C, Mostafid H, Mariappan P, Nabi G, Creswell J, Lazarowicz H, McGrath J, Taylor E, Clark E, Maclennan G, Norrie J, Hall E, Heer R. Photodynamic versus white light-guided treatment of non-muscle invasive bladder cancer: a study protocol for a randomised trial of clinical and cost-effectiveness. BMJ Open 2019; 9:e022268. [PMID: 31481549 PMCID: PMC6731798 DOI: 10.1136/bmjopen-2018-022268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Bladder cancer is the most frequently occurring tumour of the urinary system. Ta, T1 tumours and carcinoma in situ (CIS) are grouped as non-muscle invasive bladder cancer (NMIBC), which can be effectively treated by transurethral resection of bladder tumour (TURBT). There are limitations to the visualisation of tumours with conventional TURBT using white light illumination within the bladder. Incomplete resections occur from the failure to identify satellite lesions or the full extent of the tumour leading to recurrence and potential risk of disease progression. To improve complete resection, photodynamic diagnosis (PDD) has been proposed as a method that can enhance tumour detection and guide resection. The objective of the current research is to determine whether PDD-guided TURBT is better than conventional white light surgery and whether it is cost-effective. METHODS AND ANALYSIS PHOTO is a pragmatic multicentre randomised controlled trial (open parallel group, non-masked and superiority trial) comparing the intervention of PDD-guided TURBT with standard white light resection in newly diagnosed intermediate and high risk NMIBC within the UK National Health Service setting. Clinical effectiveness is measured with time to recurrence. Cost-effectiveness is assessed within trial via the calculation of incremental cost per recurrence avoided and incremental cost per quality-adjusted life per year gained over 3 years and over long term through a modelling exercise over patients' lifetime. ETHICS AND DISSEMINATION Formal ethics review was undertaken with a favourable opinion, in line with UK regulatory procedures (REC reference number: 14/NE/1062). If reductions in time to recurrence is associated with long-term patient benefits, the cost-effectiveness evaluation will provide further evidence to inform adoption of the technology. Findings will be shared in lay media such as patient and charity forums and will be presented at key meetings and published in academic literature.Trial registration number ISRCTN84013636.
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Affiliation(s)
- Zafer Tandogdu
- Urology, Northern Institute for Cancer Research, Newcastle upon Tyne, UK
| | - Rebecca Lewis
- Urology and Head and Neck Trials Team, Institute of Cancer Research, London, UK
| | - Anne Duncan
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Steven Penegar
- Urology and Head and Neck Trials Team, Institute of Cancer Research, London, UK
| | - Alison McDonald
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Luke Vale
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Jing Shen
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - John D Kelly
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Robert Pickard
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - James N Dow
- Department of Surgery, University of Aberdeen, Aberdeen, UK
| | - Craig Ramsay
- Health Service Research Unit, University of Aberdeen, Aberdeen, UK
| | - Hugh Mostafid
- Urology, Hampshire Hospitals NHS Foundation Trust, Winchester, UK
| | | | - Ghulam Nabi
- Department of Medicine, University of Dundee, Dundee, UK
| | - Joanne Creswell
- Urology, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Henry Lazarowicz
- Urology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - John McGrath
- Department of Urology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Emma Clark
- Urology, Northern Institute for Cancer Research, Newcastle upon Tyne, UK
| | - Graeme Maclennan
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Emma Hall
- Urology and Head and Neck Trials Team, The Institute of Cancer Research, London, UK
| | - Rakesh Heer
- Urology, Northern Institute for Cancer Research, Newcastle upon Tyne, UK
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Jian X, Shen M, Liao G. Definitive BCG immunotherapy versus radical cystectomy in intermediate or high-risk nonmuscle invasive bladder cancer patients: A retrospective study. Medicine (Baltimore) 2019; 98:e16873. [PMID: 31490371 PMCID: PMC6739020 DOI: 10.1097/md.0000000000016873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
At present, intravesical Bacillus Calmette-Guerin (BCG) immunotherapy is recommended for prophylaxis purposes after transurethral resection of bladder tumor, but has chances of recurrence. Radical cystectomy reduces the risk of recurrence in bladder cancer patients, but may have chances of postoperative complications. The objective of the study was to test the hypothesis that radical cystectomy has overtreatment and definitive BCG immunotherapy has undertreatment in intermediate or high-risk nonmuscle invasive bladder cancer patients. Data regarding biopsies, ultrasound, the computed tomography scan, adopted treatment strategy, treatment-emergent adverse effect, and a follow-up period of 312 patients with confirmed nonmuscle invasive bladder cancer (pTa, pTis, or pT1 stage; intermediate or high-risk cancer) were reviewed. Patients who had received definitive intravesical BCG immunotherapy were included in BCG group (n = 210) and those who underwent radical cystectomy were included in RXC group (n = 87). Clinical decision-making for treatment strategies was evaluated for both groups. Cystitis was frequently observed in all patients who received BCG immunotherapy. In RXC group, ileus was frequently observed in all patients in early days after the operation. During 2 years of the follow-up period, biopsies, ultrasound, and the computed tomography scan reported that BCG group had fewer numbers of negative cancer patients after treatment than the RXC group after surgery (P < .0001). Total expenditure for BCG immunotherapy was higher than radical cystectomy (22,945 ± 945 ¥/patient vs 17,985 ± 545 ¥/patient; P < .0001). Definitive BCG immunotherapy had undertreatment and radical cystectomy had overtreatment for intermediate or high-risk invasive bladder cancer patients (level of evidence III).
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Affiliation(s)
- Xiaoming Jian
- Department of Urology, Shidong Hospital of Yangpu District, Shanghai
| | - Mingkang Shen
- Department of Urology, Shidong Hospital of Yangpu District, Shanghai
| | - Guodong Liao
- Department of Urology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
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Chappidi MR, Kates M, Stimson CJ, Johnson MH, Pierorazio PM, Bivalacqua TJ. Causes, Timing, Hospital Costs and Perioperative Outcomes of Index vs Nonindex Hospital Readmissions after Radical Cystectomy: Implications for Regionalization of Care. J Urol 2017; 197:296-301. [PMID: 27545575 PMCID: PMC5241219 DOI: 10.1016/j.juro.2016.08.082] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE We compared the timing, causes, hospital costs and perioperative outcomes of index vs nonindex hospital readmissions after radical cystectomy. MATERIALS AND METHODS The 2013 Nationwide Readmissions Database was queried for patients with bladder cancer undergoing cystectomy. Sociodemographic characteristics, hospital costs and causes of readmission were compared among index and nonindex readmitted patients. Univariable and multivariable logistic regression models were used to identify predictors of nonindex readmissions, mortality during the first readmission and subsequent readmission. RESULTS Among 4,991 patients identified 29% (1,447) and 11% (571) experienced an index and nonindex readmission, respectively. Compared to index readmissions, nonindex readmissions were more likely late readmissions (p <0.001) of older patients (p=0.047) who underwent cystectomy at higher volume hospitals (p=0.02) and were readmitted to hospitals located in less populated areas (p <0.001). Compared to index readmissions the percentage of nonindex readmissions for cardiovascular complications was higher (7.6% vs 2.9%, p=0.003), while the percentage of nonindex readmissions for gastrointestinal (6.0% vs 11.0%, p=0.04) and wound (5.3% vs 16.7%, p=0.0001) complications was lower. Predictors of nonindex readmission included longer length of stay (OR 1.02; 95% CI 1.001, 1.04), patient location in less populated areas, nonteaching hospital (OR 0.52; 95% CI 0.31, 0.86) and discharge to facility (OR 2.82; 95% CI 1.75, 4.55) or with home health (OR 1.49; 95% CI 1.05, 2.10). Nonindex readmissions had comparable mean readmission hospital costs ($14,147 vs $15,102, p=0.7), in-hospital mortality (OR 1.11; 95% CI 0.42, 2.87) and subsequent readmission (OR 1.32; 95% CI 0.87, 2.00) to index readmissions. CONCLUSIONS This nationally representative study of patients undergoing radical cystectomy demonstrated comparable perioperative outcomes and hospital costs between index and nonindex readmitted patients, which supports the continued regionalization of cystectomy care.
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Affiliation(s)
- Meera R Chappidi
- James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Max Kates
- James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - C J Stimson
- James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael H Johnson
- James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Phillip M Pierorazio
- James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Trinity J Bivalacqua
- James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract
The purpose of this paper is to provide a current view of the economic burden of bladder cancer, with a focus on the cost effectiveness of available interventions. This review updates a previous systematic review and includes 72 new papers published between 2000 and 2013. Bladder cancer continues to be one of the most common and expensive malignancies. The annual cost of bladder cancer in the USA during 2010 was $US4 billion and is expected to rise to $US5 billion by 2020. Ten years ago, urinary markers held the potential to lower treatment costs of bladder cancer. However, subsequent real-world experiments have demonstrated that further work is necessary to identify situations in which these technologies can be applied in a cost-effective manner. Adjunct cytology remains a part of diagnostic standard of care, but recent research suggests that it is not cost effective due to its low diagnostic yield. Analysis of intravesical chemotherapy after transurethral resection of bladder tumor (TURBT), neo-adjuvant therapy for cystectomy, and robot-assisted laparoscopic cystectomy suggests that these technologies are cost effective and should be implemented more widely for appropriate patients. The existing literature on the cost effectiveness of bladder cancer treatments has improved substantially since 2000. The body of work now includes many new models, registry analyses, and real-world studies. However, there is still a need for new implementation guidelines, new risk modeling tools, and a better understanding of the empirical burden of bladder cancer.
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Gorin MA, Kates M, Mullins JK, Pierorazio PM, Matlaga BR, Schoenberg MP, Bivalacqua TJ. Impact of hospital volume on perioperative outcomes and costs of radical cystectomy: analysis of the Maryland Health Services Cost Review Commission database. Can J Urol 2014; 21:7102-7107. [PMID: 24529009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION The objective of this study was to evaluate the impact of hospital case volume on perioperative outcomes and costs of radical cystectomy (RC) after controlling for differences in patient case mix. MATERIALS AND METHODS The Maryland Health Services Cost Review Commission database was queried for patients who underwent an open RC between 2000 and 2011. Patients were divided into tertiles based on hospital case volume. Groups were compared for differences in length of intensive care unit (ICU) stay, length of total hospital stay, rate of in-hospital deaths and procedure-related costs. RESULTS In total, 1620 patients underwent a RC during the study period. Of these patients, 457 (28.2%) underwent surgery at 37 low volume centers, 465 (28.7%) at six mid volume centers and 698 (43.1%) at a single high volume center. The mean case volume of each group was 1.1, 7.0 and 63.5 RC/center/year, respectively. After controlling for marked differences in patient case mix, having surgery at the single high-volume center was independently associated with a decrease in length of ICU stay (coefficient = -0.41 days, 95% CI -0.78--0.05, p = 0.03), in-hospital mortality (OR 0.18, 95% CI 0.04-0.80, p = 0.02) and total medical costs (coefficient = -2.91k USD, 95% CI -4.15--1.67, p < 0.001). Decreased total costs were driven by reductions in charges associated with the operating room, drugs, radiology tests, labs, supplies and physical/occupational therapy (all p < 0.001). CONCLUSIONS Undergoing RC at a high volume medical center was associated with improved outcomes and reduced costs. These data support the centralization of RC to high volume centers.
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Leow JJ, Reese SW, Jiang W, Lipsitz SR, Bellmunt J, Trinh QD, Chung BI, Kibel AS, Chang SL. Propensity-matched comparison of morbidity and costs of open and robot-assisted radical cystectomies: a contemporary population-based analysis in the United States. Eur Urol 2014; 66:569-76. [PMID: 24491306 DOI: 10.1016/j.eururo.2014.01.029] [Citation(s) in RCA: 171] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 01/19/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Radical cystectomy (RC) is a morbid procedure associated with high costs. Limited population-based data exist on the complication profile and costs of robot-assisted RC (RARC) compared with open RC (ORC). OBJECTIVE To evaluate morbidity and cost differences between ORC and RARC. DESIGN, SETTING, AND PARTICIPANTS We conducted a population-based, retrospective cohort study of patients who underwent RC at 279 hospitals across the United States between 2004 and 2010. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariable logistic and median regression was performed to evaluate 90-d mortality, postoperative complications (Clavien classification), readmission rates, length of stay (LOS), and direct costs. To reduce selection bias, we used propensity weighting with survey weighting to obtain nationally representative estimates. RESULTS AND LIMITATIONS The final weighted cohort included 34 672 ORC and 2101 RARC patients. RARC use increased from 0.6% in 2004 to 12.8% in 2010. Major complication rates (Clavien grade ≥ 3; 17.0% vs 19.8%, p = 0.2) were similar between ORC and RARC (odds ratio [OR]: 1.32; p = 0.42). RARC had 46% decreased odds of minor complications (Clavien grade 1-2; OR: 0.54; p = 0.03). RARC had $4326 higher adjusted 90-d median direct costs (p = 0.004). Although RARC had a significantly shorter LOS (11.8 d vs 10.2 d; p = 0.008), no significant differences in room and board costs existed (p = 0.20). Supply costs for RARC were significantly higher ($6041 vs $3638; p < 0.0001). Morbidity and cost differences were not present among the highest-volume surgeons (≥ 7 cases per year) and hospitals (≥ 19 cases per year). Limitations include use of an administrative database and lack of oncologic characteristics. CONCLUSIONS The use of RARC has increased between 2004 and 2010. Compared with ORC, RARC was associated with decreased odds of minor but not major complications and with increased expenditures attributed primarily to higher supply costs. Centralization of ORC and RARC to high-volume providers may minimize these morbidity and cost differences. PATIENT SUMMARY Using a US population-based cohort, we found that robotic surgery for bladder cancer decreased minor complications, had no impact on major complications and was more costly than open surgery.
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Affiliation(s)
- Jeffrey J Leow
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephen W Reese
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wei Jiang
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stuart R Lipsitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joaquim Bellmunt
- Dana-Farber/Brigham and Women's Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Dana-Farber/Brigham and Women's Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA
| | - Adam S Kibel
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Dana-Farber/Brigham and Women's Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Steven L Chang
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Dana-Farber/Brigham and Women's Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
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Abstract
OBJECTIVE The total costs of radical cystectomy comprise a significant part of the total costs of bladder cancer treatment. The aims of this study were to determine the costs of cystectomy, with and without complications, and to investigate related prognostic factors. MATERIAL AND METHODS The clinical records and relevant economic files of 70 consecutive patients operated on between 1994 and 1998 were studied. Uni- and multivariate analyses were performed on 22 variables of possible prognostic significance to high total costs. RESULTS The total (median) costs for 53 uncomplicated and 17 complicated cystectomies were 181,096 and 290,625 SEK, respectively. The preoperative variables (patient characteristics) had no or minimal prognostic significance for high total costs. High peri-operative blood loss was the most important factor associated with high total hospital costs for radical cystectomy. CONCLUSIONS Total costs may be very high for a cystectomy with complications. Peri-operative blood loss was the most important factor associated with high total hospital costs for radical cystectomy due to bladder cancer. If the amount of bleeding can be influenced then substantial reductions in the total costs of cystectomy would seem possible.
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Konety BR. Reducing bladder cancer deaths: the preemptive cystectomy approach. Cancer 2009; 115:914-7. [PMID: 19152439 DOI: 10.1002/cncr.24137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gregori A, Galli S, Goumas I, Scieri F, Stener S, Gaboardi F. A cost comparison of laparoscopic versus open radical cystoprostatectomy and orthotopic ileal neobladder at a single institution. Arch Ital Urol Androl 2007; 79:127-129. [PMID: 18041364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
AIM OF THE STUDY To evaluate the specific cost components in two similar groups of patients who underwent laparoscopic or open radical cystoprostatectomy with orthotopic ileal neobladder at our Institution. METHODS Between November 2000 and July 2004, 20 men with transitional cell carcinoma of the bladder underwent laparoscopic (group 1) or open (group 2) radical cystoprostatectomy with orthotopic ileal neobladder. We evaluated the costs of hospital stay, surgical consumables and operating room occupation. At our Institution one day of hospital stay costs Euro 625 while one hour of operating room costs Euro 520 (professional fees included). RESULTS Hospital stay and operating room occupation in group 1 and 2 were statistically different (respectively 395.5 versus 275 min and 10.5 versus 18.9 days). Surgical consumables cost Euro 637 for patients in group 1 versus Euro 270 for patients in group 2. With the considered issues, at our Institution laparoscopic radical cystoprostatectomy costs Euro 10,626 whereas open radical cystoprostatectomy costs Euro 14,465. CONCLUSIONS Laparoscopic radical cystoprostatectomy seems associated with a shorter hospital stay and with a reduction of costs if compared to the open approach.
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Affiliation(s)
- Andrea Gregori
- Department of Urology, Luigi Sacco University Medical Center, Milan, Italy.
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14
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Abstract
The cost-effectiveness ratio is a popular statistic that is used by policy makers to decide which programs are cost-effective in the public health sector. Recently, the net monetary benefit has been proposed as an alternative statistical summary measure to overcome the limitations associated with the cost-effectiveness ratio. Research on using the net monetary benefit to assess the cost-effectiveness of therapies in non-randomized studies has yet to be done. Propensity scores are useful in estimating adjusted effectiveness of programs that have non-randomized or quasi-experimental designs. This article introduces the use of propensity score adjustment in cost-effectiveness analyses to estimate net monetary benefits for non-randomized studies. The uncertainty associated with the net monetary benefit estimate is evaluated using cost-effectiveness acceptability curves. Our method is illustrated by applying it to SEER-Medicare data for muscle invasive bladder cancer to determine the most cost-effective treatment protocol.
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Affiliation(s)
- Alka Indurkhya
- Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
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Barrass BJR, Thurairaja R, Collins JW, Gillatt D, Persad RA. Optimal Nutrition Should Improve the Outcome and Costs of Radical Cystectomy. Urol Int 2006; 77:139-42. [PMID: 16888419 DOI: 10.1159/000093908] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2005] [Accepted: 02/27/2006] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Nutritional support has been demonstrated to improve recovery from radical cystectomy, but is expensive and when used inappropriately may actually increase the costs and morbidity of surgery. We sought to establish national patterns of practice with regard to feeding following cystectomy in the UK. AIMS AND METHODS Following consultation with the specialist nutrition team, a questionnaire was designed to investigate the feeding strategy after cystectomy and dispatched by post to all UK urologists. RESULTS The majority (60%) of respondents employed a traditional strategy of resting the bowel and feeding orally after bowel recovery. A minority used either early total parenteral nutrition (TPN; 18.5%) or enteral nutrition (6.5%), but a larger proportion (29%) felt enteral nutrition was the 'optimal' feeding regime. Only 30% used guidelines and 52% felt trials would help to establish a nutrition strategy following cystectomy. CONCLUSION There is little evidence that TPN improves the outcome of cystectomy and it may actually increase morbidity and costs, whereas enteral nutrition may improve recovery. Despite this evidence TPN is widely used by urologists whereas enteral nutrition is used infrequently. Implementation of an evidence-based feeding regime after cystectomy is likely to reduce the morbidity and financial costs of cystectomy.
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Ludwig AT, Inampudi L, O'Donnell MA, Kreder KJ, Williams RD, Konety BR. Two-surgeon versus single-surgeon radical cystectomy and urinary diversion: Impact on patient outcomes and costs. Urology 2005; 65:488-92. [PMID: 15780361 DOI: 10.1016/j.urology.2004.10.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2004] [Accepted: 10/06/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To examine the difference in charges and outcomes between patients who underwent radical cystectomy and urinary diversion by a team of two surgeons versus a single surgeon. METHODS A total of 63 patients with bladder cancer who underwent the procedures were retrospectively analyzed. Two surgeons sequentially performed the cystectomy and ileal conduit (IC, n = 17) or neobladder (NBL, n = 18) or a single surgeon performed both the cystectomy and IC (n = 21) or NBL (n = 7). Procedure-related charges, hospital charges, operating room time, length of stay, and complications were compared between the two groups. RESULTS For the IC patients, the two-surgeon team had 60% greater mean surgeon charges (P <0.0001), 23% lower mean anesthesia charges (P <0.0001), 121 minutes shorter operating room time (P = 0.001), and 30% lower operating room charges (P = 0.001). For the NBL patients, the two-surgeon team had 32% greater surgeon charges (P <0.0001), 22% lower anesthesia charges (P = 0.003), 149 minutes shorter operating room time (P <0.0001), and 41% less operating room charges (P <0.0001). No differences were found in total hospital charges. The NBL patients who underwent surgery by two surgeons had a longer length of stay (P = 0.008). No differences were found in complications between the groups. CONCLUSIONS For IC patients, our data showed no differences in the average overall charges, whether a two-surgeon team or a single surgeon performed the procedure. Additional reductions in hospital charges could offset the greater physician charges in the NBL patients and allow full realization of the benefit from the shorter operative time with the two-surgeon team.
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Affiliation(s)
- Aaron T Ludwig
- Department of Urology, University of Iowa College of Medicine, Iowa City, Iowa 52242-1089, USA
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Konety BR, Dhawan V, Allareddy V, O'Donnell MA. ASSOCIATION BETWEEN VOLUME AND CHARGES FOR MOST FREQUENTLY PERFORMED AMBULATORY AND NONAMBULATORY SURGERY FOR BLADDER CANCER. IS MORE CHEAPER? J Urol 2004; 172:1056-61. [PMID: 15311037 DOI: 10.1097/01.ju.0000136382.51688.21] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE We investigated the relationship between provider volume and charges for transurethral bladder tumor resection (TURBT) and radical cystectomy in patients with bladder cancer. MATERIALS AND METHODS The National Inpatient Sample (1988 to 1999) of the Health Care Utilization Project, and State Ambulatory Surgery Databases for Wisconsin and Florida (2000 data set) were used for analysis. All patients with bladder cancer who had undergone radical cystectomy or TURBT as the principal procedure were identified. Hospitals and surgeons were categorized into terciles of volume based on the average number performed per year. The average hospital charge per discharge/procedure corrected to 2000 levels was calculated. One-way ANOVA with the Bonferroni correction was used to compare charges between different volume levels. RESULTS A total of 13,498 patients who underwent radical cystectomy and 5,954 who underwent TURBT were included in the analysis. Charges for radical cystectomy were 5,648 USD lower at high volume hospitals than at low volume hospitals (p <0.001). High volume surgeons were 2,976 USD less expensive than low volume surgeons (p =0.054). For TURBT total hospital charges at high volume hospitals were 1,013 USD more than at low volume hospitals (p <0.0001), while average total hospital charges for procedures performed by high volume surgeons were 919 USD less compared to low volume surgeons (p <0.0001). CONCLUSIONS High risk inpatient procedures for bladder cancer such as cystectomy, which are more influenced by systems of care, are less expensive to perform at high volume centers. Lower risk ambulatory procedures for bladder cancer, such as TURBT, which are not influenced by systems of care, may be more cost efficiently performed by high volume surgeons at low volume centers.
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Affiliation(s)
- Badrinath R Konety
- Departments of Urology, University of Iowa, 200 Hawkins Drive, 3RCP, Iowa City, Iowa 52242-1089, USA.
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18
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Abstract
OBJECTIVE To evaluate the costs of bladder tumour treatment and follow-up. MATERIAL AND METHODS The incidence of bladder tumours, both new and recurrences, and the cost of bladder tumour treatments with curative intent were registered during a 4-year period (1994-97). RESULTS The incidence of new tumours varied from year to year, in contrast to the number of recurrent tumours, which remained remarkably stable. The total cost of bladder cancer diagnosis, treatment and follow-up was almost 7,000,000 SEK per year (2,800,000 SEK per 100,000 inhabitants per year). The number of therapeutic events per year remained stable at 256 +/- 17 (102 per 100,000 inhabitants per year). Cystectomies were responsible for 34% of the expenditure and transurethral procedures for 40%. Follow-up cystoscopies accounted for only 13% of the total cost. One-third of the routine follow-up cystoscopies resulted in a therapeutic procedure. The cost of transurethral resections and extirpations was approximately five times higher when performed with the patient hospitalized compared to when performed as day-care surgery. CONCLUSIONS A reduction in the number of follow-up cystoscopies will only produce marginal economic savings. Further savings could be made if more transurethral resections and extirpations/fulgurations were performed on an outpatient basis. Another important goal is to reduce the median cost per cystectomy.
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Affiliation(s)
- Hans Hedelin
- Department of Urology, Kärnsjukhuset, Skövde, Sweden.
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Coblentz TR, Mills SE, Theodorescu D. Impact of second opinion pathology in the definitive management of patients with bladder carcinoma. Cancer 2001; 91:1284-90. [PMID: 11283928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND The accurate diagnosis, staging, and grading of bladder neoplasms depend heavily on the interpretation of biopsies and transurethral resection (TUR) specimens. Although many centers require review of outside pathologic material before definitive treatment such as radical cystectomy, the authors are unaware of data supporting the utility of this approach in urothelial (transitional cell) carcinoma. The authors therefore examined the clinical and cost impact of pathologic review on patients referred to an academic urology department for treatment of bladder neoplasia. METHODS The pathologic material from 97 patients referred to an academic center for evaluation of urothelial carcinoma of the bladder from July 1996 to July 1999 was reviewed. This material was received from 30 community hospitals and 4 academic centers. The 97 patients had undergone 131 (mean, 1.35; range, 1-10) biopsies or TUR procedures before referral. Surgical pathologists at the authors' institution reviewed all outside patient material, and discordant cases were rereviewed by one of the authors (S.E.M), an experienced genitourinary pathologist. Follow-up chart review was performed in discordant cases to determine clinical and pathologic outcomes. RESULTS Upon review at the authors' institution, 24 of 131 (18%) specimens with a referring diagnosis of urothelial carcinoma exhibited significant discrepancies with regard to the diagnosis, stage, grade, or tumor histologic type made at the outside institution. Four tumors (3%) were found to be nonurothelial neoplasms. Five specimens (4%) were judged inadequate for staging because they contained no muscularis propria. Three patients were upstaged, including two patients shown to have muscle invasive disease. Eight patients were downstaged, including two patients referred with purported muscle invasive disease who were determined to have only superficial disease on pathology review. Two patients initially thought to have carcinoma in situ (tumor in situ [Tis]) showed no evidence of Tis on pathology review. One patient with purported muscle invasive disease was shown to have only metaplasia, and one patient had a highly significant change in tumor grade. As a result of the pathology review, five radical cystectomies were avoided, whereas five repeat TUR procedures were recommended for inadequate staging. One patient shown to have muscle invasion on pathology review proceeded directly to cystectomy, avoiding a planned repeat TUR. A cystectomy also was recommended to a second patient who was shown to have invasive disease by the pathology review. Pathology review of 131 specimens resulted in net savings of $86,176 or $658 per TUR reviewed. CONCLUSIONS The review of bladder pathologic materials before definitive therapy can impact clinical decisions significantly and can reduce overall expenditures for the management of this cohort of bladder carcinoma patients.
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Affiliation(s)
- T R Coblentz
- Department of Urology, University of Virginia Health Sciences Center, Charlottesville, Virginia
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Marchetti A, Wang L, Magar R, Grossman HB, Lamm DL, Schellhammer PF, Erwin-Toth P. Management of patients with Bacilli Calmette-Guérin-refractory carcinoma in situ of the urinary bladder: cost implications of a clinical trial for valrubicin. Clin Ther 2000; 22:422-38. [PMID: 10823364 DOI: 10.1016/s0149-2918(00)89011-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study was undertaken to identify the expected first- and second-year clinical costs associated with intravesical valrubicin therapy, using a decision analytic model, for patients with Bacilli Calmette-Guérin (BCG)-refractory carcinoma in situ (CIS) of the urinary bladder. BACKGROUND Cancer of the urinary bladder is the fourth most common malignancy in men and the sixth most common noncutaneous carcinoma overall. One histopathologic stage of bladder cancer is CIS, for which BCG intravesical immunotherapy is the first-line therapy. Radical cystectomy has been recommended for patients with CIS who do not respond to or become refractory to therapy with BCG. Surgery, however, may not be appropriate for all patients, especially those who are ineligible for the lengthy procedure because of advanced age or comorbidities and those who prefer alternative nonsurgical management. For these groups, intravesical valrubicin therapy is a plausible alternative. METHODS Models were developed and populated with data from 1 open-label study of 90 patients, information from the medical literature, and input from clinical experts. The analysis was conducted from the payor perspective for direct costs only. RESULTS Our data indicate that first- and second-year expected costs for valrubicin therapy are $19,912 and $23,496, respectively. Expected cost for radical cystectomy was also evaluated, since some patients may have no other option if drug therapy fails. CONCLUSION Our cost-consequence analysis and clinical data provide decision-makers with tools to aid in global budgetary projections of fractional and total expected health care costs associated with the management BCG-refractory CIS of the urinary bladder.
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Affiliation(s)
- A Marchetti
- Health Economics Research, Secaucus, New Jersey 07094, USA
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Koch MO, Smith JA. Influence of patient age and co-morbidity on outcome of a collaborative care pathway after radical prostatectomy and cystoprostatectomy. J Urol 1996; 155:1681-4. [PMID: 8627853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE We determined whether standardized care patterns developed with a collaborative care methodology can be applied successfully across all patient groups with favorable effects on cost and quality. MATERIALS AND METHODS We retrospectively analyzed financial and clinical outcomes in 109 radical retropubic prostatectomy and 47 radical cystectomy cases. Patients older than 70 years and/or with an American Society of Anethesiology status of 3 or greater were compared to younger, healthier patients undergoing these procedures. RESULTS Standardized care patterns resulted in favorable financial and clinical outcomes in high and low risk patient groups. The only apparent difference was an increased need for rehospitalization after discharge for patients undergoing radical prostatectomy with a high American Society of Anesthesiology status. CONCLUSIONS Standardized care patterns developed with a collaborative care methodology provide a high quality, cost-efficient approach to medical care. This methodology is applicable to all patient groups and is highly compatible with current medical practice.
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Affiliation(s)
- M O Koch
- Department of Urology, Vanderbilt University School of Medicine, Nashville, TN, USA
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Koch MO, Seckin B, Smith JA. Impact of a collaborative care approach to radical cystectomy and urinary reconstruction. J Urol 1995; 154:996-1001. [PMID: 7637110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE We report the results of a collaborative care program that has been developed for radical cystectomy and urinary reconstruction. MATERIALS AND METHODS All patients undergoing surgery after July 1993 were placed on a collaborative care pathway and were compared to patients undergoing the same procedure before this period. RESULTS Total adjusted hospital charges decreased from $31,174 to $19,479. Hospital stay decreased from 12.7 to 10.3 days. There were also decreases in duration of surgery, blood loss, intensive care unit use and postoperative morbidity rates. CONCLUSIONS Collaborative care pathways favorably affect the cost efficiency of care and provide favorable surgical outcomes.
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Affiliation(s)
- M O Koch
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee 87232-2765, USA
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Shanberg AM, Marinelli D, Tansey LA, Sawyer DE. Cost analysis of neodymium-YAG laser versus transurethral resection treatment of superficial bladder carcinoma. Int Surg 1993; 78:350-1. [PMID: 8175267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
We have analyzed a group of patients treated by various urologists with both neodymium-YAG laser photoirradiation and transurethral resection in the treatment of superficial bladder carcinoma. The average hospitalization for the group of patients treated by the laser was significantly shorter than the group of patients treated by transurethral resection of the bladder tumor. The complications were similar. The cost savings to patients treated by laser photoirradiation appears to be significantly greater in laser groups of patients as opposed to conventional transurethral resection techniques.
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Affiliation(s)
- A M Shanberg
- Department of Urology, University of California, Irvine
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