Elsevier

Urology

Volume 68, Issue 3, September 2006, Pages 549-553
Urology

Adult urology
Clinical model of lifetime cost of treating bladder cancer and associated complications

This study was presented, in part, at the 17th International Symposium of the Multinational Association of Supportive Care in Cancer (MASCC), Geneva, Switzerland, July 2005.
https://doi.org/10.1016/j.urology.2006.03.062Get rights and content

Abstract

Objectives

To estimate the lifetime cost of bladder cancer and the contribution of complications to the total costs.

Methods

We reviewed the medical records of a retrospective cohort of 208 patients with bladder cancer who registered at our comprehensive cancer center from 1991 to 1999. We multiplied the number of resources used during management of bladder cancer by their unit charges. We converted charges into costs using the Medicare cost-to-charge ratio and inflated these to 2005 U.S. dollars. We estimated future costs by creating two extreme hypothetical scenarios. In the best-case scenario, we assumed patients with superficial disease developed recurrences at the cohort’s mean rate and that patients with muscle-invasive disease were disease free after definitive therapy. Survival was based on the U.S. life expectancy in both cases. In the worst-case scenario, we assumed patients with superficial disease developed muscle-invasive disease and that all patients subsequently died of bladder cancer.

Results

The average cost of bladder cancer was $65,158 among the cohort patients. Sixty percent of this cost ($39,393) was associated with surveillance and treatment of recurrences, and 30% ($19,811) was attributable to complications. The lifetime cost of bladder cancer was lower for the worst-case scenario ($99,270) than for the best-case scenario ($120,684). However, a greater proportion of the costs were attributable to complications with the worst-case scenario (43%, $42,290) compared with the best (28%, $34,169).

Conclusions

The management of bladder cancer and its associated complications results in a major economic burden. More cost-effective surveillance strategies and approaches for preventing complications are crucial to minimizing the disease’s clinical and economic consequences.

Section snippets

Material and methods

We obtained clinical and resource use data by reviewing the medical records of a retrospective cohort of 306 consecutive Houston-area patients who presented to The University of Texas M.D. Anderson Cancer Center (MDACC) with transitional cell carcinoma of the bladder from January 1, 1991 to December 31, 1999. The cohort was limited to patients who resided in the Houston area (ie, Harris County and its six contiguous counties) to ensure complete ascertainment of all costs of cancer care. Of the

Patient Characteristics and Outcomes

A total of 208 patients with bladder cancer were eligible for the analysis. Of these, 97 (47%) were younger than 65 years of age at registration, 156 (75%) were men, and 177 (85%) were white. Most, 147 patients (71%), were initially diagnosed with superficial disease (American Joint Committee on Cancer Stage 1 or lower), and the remaining 61 (29%) already had muscle-invasive disease (American Joint Committee on Cancer Stage 2 or greater) at the initial diagnosis. Of the 208 patients, 186 (89%)

Comment

Our estimates of the lifetime cost for treating bladder cancer ($65,158 for the cohort, $99,270 for the worst-case scenario and $120,684 for the best-case scenario) have indicated that the economic burden caused by the disease in patients of all ages treated at a comprehensive cancer center can be substantial. Most importantly, our study has shown that complications significantly contribute to the lifetime costs of managing bladder cancer. Almost one third of the total costs were attributed to

Conclusions

The management of bladder cancer, particularly surveillance for recurrence and the treatment of the eventual recurrences, results in major clinical and economic burdens. Complications associated with bladder cancer and its treatment contribute significantly to the disease’s lifetime costs. Identifying more cost-effective surveillance strategies and approaches for preventing bladder cancer complications is crucial to minimizing the disease’s clinical and economic consequences.

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This study was supported, in part, by a grant from Pharmacia, Incorporated (formerly Searle).

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