PD17-02: Cost Implications of Infectious Complications Following Prostate Biopsies in The United States

Sharon White*, Eric Ballon-Landa, MD, Michael Bronsert, Denver, CO, Boris Gershman, Boston, MA, Peter Clark, Charlotte, NC, Granville Lloyd, Jeffrey Morrison, Rodrigo Rodrigues-Pessoa, Denver, CO, Marc Smaldone, Philadelphia, PA, Anessa Sax-Bolder, Simon Kim, Denver, CO

Introduction: Infectious complications following transrectal ultrasound prostate biopsies (TRUS-PB) represent a growing burden in the U.S. Understanding the health care costs attributable to these adverse outcomes following this common urologic procedure is essential but remains largely unknown. Herein, we describe the economic burden attributable to post TRUS-PB infectious complications from a population-based cohort of privately-insured patients.

Methods: From 2010 to 2015, we identified all patients who underwent an incident TRUS PB from MarketScan. Health care costs and patient out-of-pocket costs due to infectious complications requiring hospital admission and emergency room (ER) visits within 30 days of the TRUS-PB represented the primary outcome.  Multivariable analyses were used to identify patient characteristics associated with higher health care and out-of-pocket costs.

Results: Overall, 193,490 patients underwent TRUS-PB and the mean age was 57.6 years (SD: 5.0).  The rates of infectious complications requiring ER visits and hospital admissions were 0.4 and 1.2 per 100 prostate biopsies.  Compared to patients who did not experience any infectious complications, patient admitted to hospital within 30 days had higher health care costs ($14,057 vs. $625; p < 0.001) and out-of-pocket costs ($80 vs. $9; p<.0001).  Similarly, patients who required ER visits also had higher total health care costs compared to those who did not experience infectious complications ($141 vs. $4; p<.0001). Higher aggregate health care costs ($14,198 vs. $629; p<.0001) and out-of-pockets costs ($89 vs. $18; p<.0001) were observed for patients who sustained infectious complications. The total health care cost for infections was $38,234,689 On multivariable analyses, patients who had Elixhauser index defined comorbidities had total health care costs (p < 0.001).

Conclusions: Infectious complications following TRUS-PB are associated with significant economic burden to the health care system and patients. Efforts to reduce post TRUS-PB infectious complications can significantly improve value-based health care delivery.

Source of Funding: This study was supported by the Schramm Foundation.