Trimodal Therapy vs Radical Cystectomy for Patients With Localized Bladder Cancer

02/07/18

Researchers compared the overall survival, cancer-specific survival, and associated costs of trimodal therapy versus radical cystectomy for patients with localized muscle-invasive bladder cancer.

Results were presented at the 2018 Genitourinary Cancers Symposium (February 8-10, 2018; San Francisco, CA).

Radical cystectomy is the guideline-recommended treatment for muscle-invasive bladder cancer. However, trimodal therapy has begun to resurge in recent years as an alternative treatment option, despite limited data on comparative outcomes and attributable costs.

Stephen B Williams, MD, urologic oncologist, MD Anderson Cancer Center (Pearland, TX), and colleagues conducted a study to compare trimodal therapy with radical cystectomy in terms of survival outcomes and costs for patients with localized muscle-invasive bladder cancer. A total of 3200 patients (aged at least 66 years) diagnosed with stage II-IV disease from 2002 through 2011 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare data base were analyzed.

Researchers utilized Cox regression analysis and propensity score matching methods to determine predictors for overall and cancer-specific survival. After propensity score matching, 687 patients underwent trimodal therapy and 687 patients underwent radical cystectomy.

Results of the study showed that patients in the trimodal therapy group were subjected to worse overall survival (HR, 1.49; 95% CI, 1.31-1.69; P < .001) and cancer-specific survival (HR, 1.55; 95% CI, 1.32-1.83; P < .001) compared with those in the radical cystectomy group.

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While no difference in cost was observed at 30 days, median total costs were significantly higher for those receiving trimodal therapy compared with those receiving radical cystectomy at 90 days ($73,420 vs $63,355, respectively; P < .001) and 180 days ($164,720 vs $98,005; P < .001). Importantly, extrapolating these figures to the total United States population resulted in excess spending of $179 million for trimodal therapy in 2011.

“These findings have important health policy implications regarding appropriate use of high-value based care among patients who are candidates for either treatment,” Dr Williams and colleagues wrote.—Zachary Bessette