(UroToday.com) The adoption of Robotic Radical Cystectomy (RRC) has been steadily rising over the past years. The cost-effectiveness of the procedure remains controversial. The authors aimed to compare 2-year
resource utilization (RU) between RRC and Open radical cystectomy (ORC).
The authors queried Optum Clinformatics DataMart (OptumInsight, Eden Prairie, MN), a de-identified commercial insurance claims database for eligible patients. They identified all patients who underwent radical cystectomy (RC) for bladder cancer between 2014 and 2017. Patients with <2 years of continuous enrollment following RC were excluded. Patients were then stratified according to approach into RRC and ORC. Resource utilization was determined by evaluating the incident hospitalization costs as well as the frequency and total standardized costs for each subsequent inpatient and outpatient visit. Multivariate generalized linear models were used to determine the impact of surgical approach on subsequent resource utilization; The number of outpatient visits and hospitalizations were modeled using a Poisson distribution, while cost outcomes were modeled using gamma distribution. Other outcomes were modeled with binomial frequency distribution.
A total of 2373 patients were identified, of which 1353 had continuous enrollment for ≥2 years. Of those patients, 798 (59%) underwent RRC while 555 (41%) underwent ORC. Patients who underwent RRC had significantly shorter median [IQR] length of hospital stay (5 days [2 - 8]) compared to ORC (7 [5 - 10], p<0.0001). RRC was associated with lower inpatient costs for incident hospitalization ($29,142 vs. $42,329, p<0.001), and fewer subsequent hospitalizations (165 (30%) vs. 298 (37%) for ≥2 hospitalizations) compared to ORC. There was no difference in median number of subsequent outpatient visits (9 [3 - 19] and 10 [4 - 20], p=0.1), cost of outpatient visits ($12,157 vs. $12,591; p=0.2), number of urology outpatient and emergency department visits. RRC was also associated with lower rates of complications (Table 1) including wound dehiscence (4% vs. 8%, p=0.002), acute kidney failure (3% vs 5%, p=0.007), ileus (2% vs 5%, p=0.005), UTI (53% vs 61%, p=0.002), and lower transfusions (2% vs 6%, p<0.001)
The authors concluded that RRC was associated with lower 2-year RU including lower incident hospitalization costs as well as fewer subsequent hospitalizations compared to RRC. Limitations include lack of robot acquisition and maintenance costs along with important confounders such as surgeon, hospital, and patient characteristics which may impact costs. Moreover, prior healthcare resource utilization may drive costs following therapy. These data highlight the substantial costs associated with bladder cancer and opportunities for improved cost containment regardless of surgical approach.
Presented by: Keri Rowley, MD, Department of Urology, UT Health San Antonio, UT Health Science Center at Houston
Written by: Stephen B. Williams, MD, MBA, MS @SWilliams_MD on Twitter during the South Central Section American Urological Association Annual Meeting, September 6-10, 2022, Coronado, CA