scholarly journals Comparison of outcomes between trimodal therapy and radical cystectomy in muscle-invasive bladder cancer: a propensity score matching analysis

Oncotarget ◽  
2017 ◽  
Vol 8 (40) ◽  
pp. 68996-69004 ◽  
Author(s):  
Yeon Joo Kim ◽  
Sang Jun Byun ◽  
Hanjong Ahn ◽  
Choung-Soo Kim ◽  
Beom-Sik Hong ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Radical Cystectomy ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Propensity Score Matching Analysis ◽  
Trimodal Therapy ◽  
Muscle Invasive

Survival outcomes and costs of trimodal therapy compared with radical cystectomy among patients diagnosed with localized muscle-invasive bladder cancer.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 421-421
Author(s):  
Stephen Bentley Williams ◽  
Yong Shan ◽  
Usama Jazzar ◽  
Hemalkumar B Mehta ◽  
Jacques G. Baillargeon ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Radical Cystectomy ◽  
Policy Implications ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Cancer Specific Survival ◽  
Trimodal Therapy ◽  
Muscle Invasive

421 Background: Radical cystectomy is the guideline-recommended treatment for muscle-invasive bladder cancer. Recently there has been a resurgence in trimodal therapy with limited data on comparative outcomes, and especially attributable costs. Methods: A total of 3,200 patients aged 66 years or older diagnosed with clinical stage T2-4a bladder cancer from January 1, 2002- December 31, 2011 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare data were analyzed. Cox regression analysis and propensity score matching methods were used to determine predictors for overall and cancer-specific survival. Results: A total of 3,200 patients met inclusion criteria. After propensity score matching, 687 patients underwent trimodal therapy and 687 patients underwent radical cystectomy. Patients who underwent trimodal therapy had significantly decreased overall (Hazard Ratio (HR) 1.49, 95% Confidence Interval (CI), 1.31-1.69, p < 0.001) and cancer-specific (HR 1.55, 95% CI 1.32-1.83, p < 0.001) survival, respectively. While there was no difference in costs at 30 days, median total costs were significantly higher with trimodal therapy than radical cystectomy at 90-d ($63,355 vs. $73,420, p < 0.001) and 180-d ($98,005 vs. $164,720, p < 0.001), respectively. Extrapolating these figures to the total US population results in excess spending of $179 million for trimodal therapy compared to less costly radical cystectomy for patients diagnosed in 2011. Conclusions: Trimodal therapy was associated with significantly decreased overall and cancer-specific survival resulting in excess national spending of $179 million in 2011 compared with radical cystectomy. These findings have important health policy implications regarding appropriate use of high-value based care among patients who are candidates for either treatment.

Comparing Prognosis Associated with Partial Cystectomy and Trimodal Therapy for Muscle-Invasive Bladder Cancer Patients

2021 ◽  
pp. 1-12
Author(s):  
Quanxin Su ◽  
Shenglin Gao ◽  
Chao Lu ◽  
Xingyu Wu ◽  
Li Zuo ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Partial Cystectomy ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Cox Regression Analysis ◽  
Trimodal Therapy ◽  
Muscle Invasive ◽  
Cause Specific Survival

<b><i>Objective:</i></b> This study aimed to compare the survival outcomes between trimodal therapy (TT) and partial cystectomy (PC) in muscle-invasive bladder cancer (MIBC) patients. <b><i>Methods:</i></b> The data of 13,096 patients with MIBC diagnosed between 2004 and 2015 were retrieved from the Surveillance, Epidemiology, and End Results database. Among them, 4,041 patients underwent TT and 1,670 patients underwent PC. Propensity score matching was performed to balance the characteristics between the 2 treatment groups. A multivariate Cox regression analysis model and a competing risk model were used to evaluate overall survival (OS) and cancer-specific survival. Cumulative incidence survival curves were obtained using the Kaplan-Meier method. <b><i>Results:</i></b> Results of multivariate Cox analysis before propensity score matching showed that the TT group had a 31% reduction in cause-specific survival relative to the PC group (HR: 0.69, 95% CI: 0.61–0.78, <i>p</i> &#x3c; 0.001) and a 28% reduction in OS (HR: 0.72, 95% CI: 0.66–0.79, <i>p</i> &#x3c; 0.001). After propensity score matching, the 2 groups yielded 972 patients, with 3-year cause-specific survival rates of 54.1% and 68.5% in the TT group and the PC group, respectively. <b><i>Conclusions:</i></b> Patients who underwent PC had a better prognosis than those who received TT. In addition, for MIBC patients who required bladder-sparing therapy, advanced age (≥80 years), pathological type of squamous cell carcinoma, and tumor stage of T3–4, N2–3, and M1 were independent poor prognostic factors.

scholarly journals Comparison of Costs of Radical Cystectomy vs Trimodal Therapy for Patients With Localized Muscle-Invasive Bladder Cancer

JAMA Surgery ◽  
2019 ◽  
Vol 154 (8) ◽  
pp. e191629 ◽  
Author(s):  
Stephen B. Williams ◽  
Yong Shan ◽  
Mohamed D. Ray-Zack ◽  
Hogan K. Hudgins ◽  
Usama Jazzar ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Trimodal Therapy ◽  
Muscle Invasive

Comparing costs of radical cystectomy versus trimodal therapy for patients diagnosed with localized muscle-invasive bladder cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e16021-e16021
Author(s):  
Daniel Phillips ◽  
Tamer Dafashy ◽  
Yong Shan ◽  
Mohamed Danny Ray-Zack ◽  
Hogan K Hudgins ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Clinical Stage ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Pathology Laboratory ◽  
Median Difference ◽  
Trimodal Therapy ◽  
Muscle Invasive ◽  
One Year

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.

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