Main Session
Sep
29
PQA 06 - Genitourinary Cancer, Gynecological Cancer, and Health Care Access and Engagement
3253 - National Utilization and Cost Patterns of Trimodality Therapy vs. Radical Cystectomy for Muscle-Invasive Bladder Cancer in the United States
Presenter(s)
Rod Carlo Columbres, DO, BS - Winship Cancer Institute of Emory University, Atlanta, GA
R. C. A. Columbres1,2, M. Gaonkar3, N. Sebastian4, K. Salari5, P. R. Patel6, B. Hershatter6, A. Jani7, D. Patil1, and S. A. Patel7; 1Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, 2Genitourinary Malignancies Branch, National Cancer Institute, National Institute of Health, Bethesda, MD, 3Emory University, Atlanta, GA, 4Emory Proton Therapy Center, Atlanta, OH, 5Emory University, Atlanta, GA, United States, 6Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, 7Department of Radiation Oncology, Emory University, Atlanta, GA
Purpose/Objective(s):
Trimodality therapy (TMT) is an evidence-supported bladder-preserving alternative to radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC). However, contemporary adoption patterns and cost implications across insurance types in the United States remain poorly defined. We evaluated temporal utilization trends and compared total healthcare and patient-incurred costs for TMT versus RC in Medicare and commercially insured populations.Materials/Methods:
Patients with MIBC treated with TMT or RC between 2010 and 2022 were identified from the MarketScan Medicare Supplemental (MDCR) and Commercial Claims and Encounters (CCAE) databases. Year-to-year trends in relative treatment utilization were assessed using Kendall Tau-b testing, and multivariable logistic regression was used to measure the association of clinicodemographic variables with receipt of each treatment. Propensity score matching and adjusted models were used to compare 12-month total healthcare expenditures and patient out-of-pocket costs.Results:
From 2010 to 2022, overall utilization of RC and TMT declined both for commercially insured (p=0.036) and Medicare (p=0.039) cohorts. Among 953 MDCR beneficiaries (TMT n=464; RC n=489), there was no significant association of treatment within contemporary years (i.e. 2017-2022) with receipt of TMT (adjusted OR 0.71, 95% CI 0.48-1.05; p=0.09). Among 554 CCAE beneficiaries (TMT n=142; RC n=412), similarly no significant association of treatment within contemporary years with receipt of TMT relative to RC was observed (adjusted OR 0.82, 95% CI 0.51–1.32; p=0.41). Adjusted 12-month total healthcare expenditures were comparable between TMT and RC in both MDCR ($185,811 vs $196,168; p=0.38) and CCAE ($207,097 vs $195,648; p=0.38). Patient out-of-pocket costs were also similar in MDCR ($3,386 vs $3,080; p=0.09) and CCAE ($5,265 vs $4,559; p=0.075).Conclusion:
Despite increasing guideline endorsement and technological advances in radiation delivery, national utilization of TMT for MIBC has not significantly increased over the past decade in either Medicare or commercially insured populations. Importantly, TMT was not associated with higher total healthcare expenditures or patient out-of-pocket costs compared with RC. These findings highlight a persistent gap between evidence and real-world adoption and underscore the need to address structural, referral, and access barriers to bladder-preserving care.