MP46-08: Cost and utilization of concurrent vs staged testicular implant for radical orchiectomy

Arman Walia*, San Diego, CA, Joshua Horns, Niraj Paudel, Salt Lake City, UT, Aditya Bagrodia, San Diego, CA, Jim Hotaling, Salt Lake City, UT, Tung-Chin Hsieh, San Diego, CA

Introduction: American Urological Association guidelines recommend testicular prosthesis discussion prior to orchiectomy. Utilization may be low. We investigated outcomes and care utilization between concurrent implant (CI) and staged implant (SI) insertion after radical orchiectomy

Methods: The MarketScan Commercial claims database (2008-2017) was queried for men >18-years-old who underwent radical orchiectomy for testicular tumor, stratified as orchiectomy with no implant, CI, or SI (any time post-orchiectomy). 90-day outcomes included rate of reoperation, readmission, emergency department (ED) presentation, and outpatient visits. Regression models provided rate ratio comparison

Results: 8803 (8564 no implant, 190 CI, 49 SI) patients were identified with no difference in age, Charlson comorbidity index, benefit plan, additional cancer treatment, or metastasis. Median perioperative cost at orchiectomy (+/- implant) for no implant, CI, and SI were $5682 (3648-8554), $7823 (5403-10973), and $5380 (4130-10521), respectively (p < 0.001). Median perioperative cost for SI at implantation was $8180 (4920-14591) for a total cost (orchiectomy + implant) of $13560 (5380 + 8180).

Total postoperative costs stratified by additional cancer treatment (chemotherapy, radiation, retroperitoneal surgery) are in Table 1. 90-day care utilization is in Table 2. CI patients were more likely to have follow-up (OR 2.48, p=0.006) with more visits (OR 1.54, p=0.030) compared to the SI group post-implantation, but had similar follow-up (OR 1.93, p=0.065) and less visits (OR 1.29, p=0.025) compared to the SI patients’ post-orchiectomy period. No difference in cost or rate of ED visits, readmission, or reoperation was identified.

Overall explant rates were 4.7% (9) for CI and 14.3% (7) for SI (p=0.04) with a median time to explant of 166 (135-210) and 40 (9.5-141.5) days, respectively (p=0.06). Median cost of removal was $2060 (IQR 967-2880)

Conclusions: CI placement has less total perioperative cost, lower explant rate, and similar postoperative utilization compared to SI

Source of Funding: None