Clinical model of cost of bladder cancer in the elderly

OBJECTIVES To develop a population-based clinical model of bladder cancer (BC) care costs and identify cost drivers. METHODS We retrospectively reviewed a cohort of 4863 patients with BC identified from the linked Surveillance, Epidemiology and End Results-Medicare database, aged at least 65 years and diagnosed between 1994 and 1996. We collected the records of Medicare reimbursements (a surrogate of costs) through 1998 and classified them into clinically relevant intervals and care types by disease invasiveness to derive the Cumulative costs of care. We calculated the incremental resource use costs using sex and age-matched controls from a 5% general Population sample and compared similarly matched patients with other cancer (OC). We inflated all costs to 2006 U.S. dollars. RESULTS The annual cost of care for all patients with muscle-invasive BC (MIBC) was $35.72M (95% confidence interval $35.69M to $35.75M), 70% more than the $21.03M (95% confidence interval $21.00M to $21.05M) for patients with non-MIBC. The major cost drivers, regardless of disease stage, were diagnostic/surveillance and complications, accounting for Lip to 43% and 37% of BC care costs, respectively. Comorbidity-adjusted incremental annual resource costs per patient with MIBC were more than four times greater than those for patients with non-MIBC, similar to those of OC controls (P = 0.490-0.913), except for inpatient (P = 0.002) and hospice (P < 0.001) costs, which were both statistically significantly lower. Annual adjusted incremental Medicare reimbursements totaled $36.3M for non-MIBC and $96.1 million for MIBC. CONCLUSIONS The results of this study have indicated that a reduction of BC care costs could be realized with strategies inhibiting disease progression and reducing the occurrence and severity of complications.