Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, TX.
Department of Surgery, Section of Urology, Medical College of Georgia, Augusta University, Augusta, GA.
Urology. 2021 Jan;147:127-134. doi: 10.1016/j.urology.2020.08.058. Epub 2020 Sep 24.
To compare costs associated with radical versus partial cystectomy. Prior studies noted substantial costs associated with radical cystectomy, however, they lack surgical comparison to partial cystectomy.
A total of 2305 patients aged 66-85 years diagnosed with clinical stage T2-4a muscle-invasive bladder cancer from January 1, 2002 to December 31, 2011 were included. Total Medicare costs within 1 year of diagnosis following radical versus partial cystectomy were compared using inverse probability of treatment-weighted propensity score models. Cox regression and competing risks analysis were used to determine overall and cancer-specific survival, respectively.
Median total costs were not significantly different for radical than partial cystectomy in 90 days ($73,907 vs $65,721; median difference $16,796, 95% CI $10,038-$23,558), 180 days ($113,288 vs $82,840; median difference $36,369, 95% CI $25,744-$47,392), and 365 days ($143,831 vs $107,359; median difference $34,628, 95% CI $17,819-$53,558), respectively. Hospitalization, surgery, pathology/laboratory, pharmacy, and skilled nursing facility costs contributed largely to costs associated with either treatment. Patients who underwent partial cystectomy had similar overall survival but had worse cancer-specific survival (Hazard Ratio 1.45, 95% Confidence Interval, 1.34-1.58, P < .001) than patients who underwent radical cystectomy.
While treatments for bladder cancer are associated with substantial costs, we showed radical cystectomy had comparable total costs when compared to partial cystectomy among patients with muscle-invasive bladder cancer. However, partial cystectomy resulted in worse cancer-specific survival further supporting radical cystectomy as a high-value surgical procedure for muscle-invasive bladder cancer.
比较根治性与部分膀胱切除术相关的成本。先前的研究指出根治性膀胱切除术与大量成本相关，但缺乏与部分膀胱切除术的手术比较。
共纳入 2305 例年龄在 66-85 岁之间、诊断为临床分期 T2-4a 肌层浸润性膀胱癌的患者，这些患者来自于 2002 年 1 月 1 日至 2011 年 12 月 31 日。使用逆概率治疗加权倾向评分模型比较根治性与部分膀胱切除术后 1 年内的总医疗保险费用。Cox 回归和竞争风险分析分别用于确定总生存率和癌症特异性生存率。
在 90 天（$73907 比$65721；中位数差异$16796，95%置信区间$10038-$23558）、180 天（$113288 比$82840；中位数差异$36369，95%置信区间$25744-$47392）和 365 天（$143831 比$107359；中位数差异$34628，95%置信区间$17819-$53558），根治性与部分膀胱切除术的总费用无显著差异。住院、手术、病理/实验室、药房和熟练护理机构费用主要与两种治疗方法相关。接受部分膀胱切除术的患者具有相似的总生存率，但癌症特异性生存率较差（风险比 1.45，95%置信区间，1.34-1.58，P <.001），而接受根治性膀胱切除术的患者则较差。
尽管膀胱癌的治疗方法与大量成本相关，但我们发现肌层浸润性膀胱癌患者中，根治性膀胱切除术的总费用与部分膀胱切除术相当。然而，部分膀胱切除术导致癌症特异性生存率较差，进一步支持根治性膀胱切除术作为肌层浸润性膀胱癌的高价值手术。
