1779 SURVEILLANCE GUIDELINES FOR LOW GRADE NON-INVASIVE BLADDER CANCER: A COST COMPARISON (2012)

You have accessJournal of UrologyBladder Cancer: Superficial II1 Apr 20121779 SURVEILLANCE GUIDELINES FOR LOW GRADE NON-INVASIVE BLADDER CANCER: A COST COMPARISON Ian Udell, Raj Kurpad, Angela Smith, Michael Woods, Eric Wallen, Raj Pruthi, and Matthew Nielsen Ian UdellIan Udell Chapel Hill, NC More articles by this author , Raj KurpadRaj Kurpad Chapel Hill, NC More articles by this author , Angela SmithAngela Smith Chapel Hill, NC More articles by this author , Michael WoodsMichael Woods Chapel Hill, NC More articles by this author , Eric WallenEric Wallen Chapel Hill, NC More articles by this author , Raj PruthiRaj Pruthi Chapel Hill, NC More articles by this author , and Matthew NielsenMatthew Nielsen Chapel Hill, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1796AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES An estimated 70,530 new cases of bladder cancer were diagnosed in 2010. Approximately half of all incident bladder tumors are low grade, noninvasive (Ta), with a moderate risk of recurrence and low rate of progression to muscle-invasive disease. Explicit risk stratification and lower intensity follow-up protocol for low risk disease are salient differences in the European Association of Urology (EAU) practice guidelines compared to those of the American Urological Association (AUA). Currently, the AUA does not explicitly recommend a risk stratified approach. METHODS Medicare charges for each aspect of the surveillance protocol were obtained. Annual per-protocol costs were calculated according to the AUA and EAU guidelines and extrapolated to overall 5 year costs per-patient as well as total surveillance costs for a cohort of low grade Ta patients diagnosed yearly. We assumed perfect adherence and excluded consideration of additional treatment-related costs. RESULTS Following the EAU protocol, the average cost per patient yearly and at five years for surveillance of low risk tumors would be $2,228, and $6,684 respectively. Using the AUA guidelines, the average one and five-year cost per patient is $4,456 and $13,368, respectively. For the total population of low grade Ta patients diagnosed in one calendar year, these differences result in total costs at 5 years of $235,711,260 for the EAU protocol versus $471,422,520 for the AUA protocol. Total five-year surveillance cost savings for low grade Ta disease per patient and nationally of $6,684 and $235,711,260, respectively would be obtained by adopting a surveillance schedule in accordance with risk-stratified EAU guidelines. CONCLUSIONS With an aging population and heightened economic pressure to provide cost-effective care, explicitly risk-stratifying patients could yield 50% cost savings during surveillance for low grade, noninvasive bladder cancer at one and five years. These results motivate a critical reevaluation of the cost effectiveness of guidelines recommendations for the management of low risk disease. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e718 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ian Udell Chapel Hill, NC More articles by this author Raj Kurpad Chapel Hill, NC More articles by this author Angela Smith Chapel Hill, NC More articles by this author Michael Woods Chapel Hill, NC More articles by this author Eric Wallen Chapel Hill, NC More articles by this author Raj Pruthi Chapel Hill, NC More articles by this author Matthew Nielsen Chapel Hill, NC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...