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UPJ INSIGHT Cost of Bladder Cancer Care: A Single-center Comparison of Radical Cystectomy and Trimodal Therapy

By: Diana E. Magee, MD, MPH, MSc, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, University of Toronto, Ontario, Canada; Douglas C. Cheung, MD, MBA, PhD, University of Toronto, Ontario, Canada; Amanda E. Hird, MD, MSc, University of Toronto, Ontario, Canada; Peter Chung, MBBCh, FRCR, MRCP(UK), FRCPC, University of Toronto, Ontario, Canada; Padraig Warde, MCChB, BAO, University of Toronto, Ontario, Canada; Charles Catton, MD, University of Toronto, Ontario, Canada; Alejandro Berlin, MD, MSc, University of Toronto, Ontario, Canada; Alexandre Zlotta, MD, PhD, University of Toronto, Ontario, Canada; Neil E. Fleshner, MD, MPH, University of Toronto, Ontario, Canada; Girish S. Kulkarni, MD, PhD, University of Toronto, Ontario, Canada | Posted on: 20 Jul 2023

Magee DE, Cheung DC, Hird AE, et al. Cost of bladder cancer care: a single-center comparison of radical cystectomy and trimodal therapy. Urol Pract. 2023;10(4):292-299.

Study Need and Importance

Our study evaluates the cost of providing care for muscle-invasive bladder cancer within the Canadian landscape. We compared the cost of care from diagnosis to recurrence for patients treated with either trimodal therapy (TMT) or radical cystectomy (RC). Our aim was to assess for any differences between the treatment modalities and the phases of care. This paper addresses a question that has yet to be addressed within a Canadian jurisdiction and highlights for health care decision makers the variability and timing of cost burdens.

What We Found

We found that RC has a higher burden of costs up front in the treatment phase which are related to the surgery and its complications, while TMT has a higher cost for ongoing follow-up (see Figure).

Figure. Lifetime accumulated cost per strategy. CAD indicates Canadian dollars; RC, radical cystectomy; TMT, trimodal therapy.

Limitations

Limitations of the paper include the single-center institution data collection, potential imperfect capture of patient events and loss to follow-up. As well, we did not account for indirect costs of therapy including loss of productivity or caregiver burden.

Interpretation for Patient Care

The most significant takeaway from this study for patient care is the recognition that within a single-payer health care system neither treatment modality is cost prohibitive. The 2 treatments evaluated simply have distinct cost burdens at different times in the clinical timeline.

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