Comparing direct medical care costs of patients with bladder cancer who received an ileal conduit vs. neobladder in the year following cystectomy.

Matthew P Banegas, Maureen O'Keeffe Rosetti, Scott M Gilbert, Marilyn L Kwan, Michael C Leo, Kim N Danforth, Joanna Bulkley, Sheila Weinmann, David K Yi, Valerie S Lee, Carmit McMullen
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Abstract

Purpose: Bladder cancer is 1 of the most costly cancers, however there is limited research on medical care costs by type of urinary diversion. The objective of our study was to compare medical care costs of the 2 most common urinary diversions in the year following radical cystectomy.

Methods: The Bladder Cancer Quality of Life Study included patients diagnosed with bladder cancer who underwent radical cystectomy and received an ileal conduit (IC, n = 821) or neobladder (NB, n = 181) in 3 integrated health systems. Medical care costs per patient per quarter were estimated for the year following cystectomy. Multivariable generalized linear models with a gamma distribution and log link were used to estimate mean monthly medical care costs (2022 USD$), adjusted for patient demographic and clinical characteristics.

Results: In multivariable analysis, mean monthly costs per quarter were not significantly different between IC and NB patients in the 12 months following cystectomy. Overall, mean monthly costs in IC and NB patients were highest during the first quarter and decreased thereafter. Factors associated with higher mean costs across all quarters included presence of any complications and advanced tumor stage at cystectomy (all P < 0.001).

Conclusion: Our study addresses an important knowledge gap by quantifying the medical costs of bladder cancer patients by urinary diversion type and comparing costs of different treatment approaches. Studies that assess patient-reported outcomes and out-of-pocket costs, by urinary diversion type, are warranted to inform treatment decision-making and cost conversations.

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比较接受回肠导管与新膀胱术的膀胱癌患者在膀胱切除术后一年内的直接医疗费用。
目的:膀胱癌是最昂贵的癌症之一,但按尿路改道类型划分的医疗费用研究却很有限。我们的研究旨在比较根治性膀胱切除术后一年内两种最常见的尿路改道术的医疗费用:膀胱癌生活质量研究纳入了在 3 个综合医疗系统接受根治性膀胱切除术并接受回肠导尿管(IC,n = 821)或新膀胱(NB,n = 181)的膀胱癌患者。我们估算了每位患者在膀胱切除术后一年内每季度的医疗费用。采用伽马分布和对数链接的多变量广义线性模型估算每月平均医疗费用(2022 美元),并根据患者的人口统计学特征和临床特征进行调整:在多变量分析中,IC 和 NB 患者在膀胱切除术后 12 个月内的每季度平均月费用没有显著差异。总体而言,IC 和 NB 患者的平均月费用在第一季度最高,之后有所下降。各季度平均费用较高的相关因素包括膀胱切除术时出现任何并发症和肿瘤分期较晚(所有因素的P均<0.001):我们的研究通过量化膀胱癌患者尿路改道类型的医疗成本,并比较不同治疗方法的成本,填补了一项重要的知识空白。有必要按尿路改道类型对患者报告的结果和自付费用进行评估,为治疗决策和成本对话提供依据。
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来源期刊
CiteScore
4.80
自引率
3.70%
发文量
297
审稿时长
7.6 weeks
期刊介绍: Urologic Oncology: Seminars and Original Investigations is the official journal of the Society of Urologic Oncology. The journal publishes practical, timely, and relevant clinical and basic science research articles which address any aspect of urologic oncology. Each issue comprises original research, news and topics, survey articles providing short commentaries on other important articles in the urologic oncology literature, and reviews including an in-depth Seminar examining a specific clinical dilemma. The journal periodically publishes supplement issues devoted to areas of current interest to the urologic oncology community. Articles published are of interest to researchers and the clinicians involved in the practice of urologic oncology including urologists, oncologists, and radiologists.
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