MP18-11 RISK-STRATIFIED SURVEILLANCE PROTOCOL IMPROVES COST-EFFECTIVENESS AFTER RADICAL NEPHROURETERECTOMY IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA (2018)

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma I1 Apr 2018MP18-11 RISK-STRATIFIED SURVEILLANCE PROTOCOL IMPROVES COST-EFFECTIVENESS AFTER RADICAL NEPHROURETERECTOMY IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA Momota Masaki, Hatakeyama Shingo, Tobisawa Yuki, Yoneyama Tohru, Yamamoto Hayato, Yoneyama Takahiro, Hashimoto Yasuhiro, Koie Takuya, Iwabuchi Ikuya, Ogasawara Masaru, Kawaguchi Toshiaki, and Ohyama Chikara Momota MasakiMomota Masaki More articles by this author , Hatakeyama ShingoHatakeyama Shingo More articles by this author , Tobisawa YukiTobisawa Yuki More articles by this author , Yoneyama TohruYoneyama Tohru More articles by this author , Yamamoto HayatoYamamoto Hayato More articles by this author , Yoneyama TakahiroYoneyama Takahiro More articles by this author , Hashimoto YasuhiroHashimoto Yasuhiro More articles by this author , Koie TakuyaKoie Takuya More articles by this author , Iwabuchi IkuyaIwabuchi Ikuya More articles by this author , Ogasawara MasaruOgasawara Masaru More articles by this author , Kawaguchi ToshiakiKawaguchi Toshiaki More articles by this author , and Ohyama ChikaraOhyama Chikara More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.587AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To develop a surveillance protocol with improved cost-effectiveness after radical nephroureterectomy (RNU), as the cost-effectiveness of oncological surveillance after RNU remains unclear. METHODS We retrospectively evaluated 426 patients with RNU for upper tract urothelial carcinoma (UTUC) without distant metastasis at 4 hospitals. Patients with routine oncological follow-up were stratified into normal-, high-and very high-risk groups according to a pathology-based protocol utilizing pathological stage, lymphovascular invasive(LVI)and surgical margine(SM). Cost-effectiveness of the pathology-based protocol was evaluated, and a risk score-based protocol was developed to optimize cost-effectiveness. Risk scores were calculated by adding risk factors independently associated with recurrence-free survival. Patients were stratified by low-, intermediate-and high-risk score. Estimated cost per recurrence detected by risk score-based protocols was compared. RESULTS Of 426 patients, 109 (26%) and 113 (27%) experienced visceral and intravesical recurrences, respectively. The pathology-based protocol found significant differences in recurrence-free survival in the visceral recurrence but not in the intravesical recurrence. The medical costs per visceral recurrence detected were high, especially in normal-risk (=pT2N0, LVI-, SM-) patients. We developed a risk score associated with visceral recurrence using Cox regression analysis. The risk score-based protocol was significantly more cost-effective than the pathology-based protocol. Estimated cost differences reached $747,929 per visceral recurrence detected, a suggested 55% reduction. CONCLUSIONS A risk score-stratified surveillance protocol has the potential to reduce overinvestigation after RNU without adverse effects on medical cost. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e217 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Momota Masaki More articles by this author Hatakeyama Shingo More articles by this author Tobisawa Yuki More articles by this author Yoneyama Tohru More articles by this author Yamamoto Hayato More articles by this author Yoneyama Takahiro More articles by this author Hashimoto Yasuhiro More articles by this author Koie Takuya More articles by this author Iwabuchi Ikuya More articles by this author Ogasawara Masaru More articles by this author Kawaguchi Toshiaki More articles by this author Ohyama Chikara More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...