MP39-14: Comparing Healthcare Utilization and Costs According to Renal Preservation Versus Radical Nephroureterectomy Management For Patients with Non-Metastatic Upper Tract Urothelial Carcinoma

Kathryn Fero, Los Angeles, CA, Yong Shan, Giri Movva, Jacques Baillargeon, Douglas Tyler, GALVESTON, TX, Karim Chamie, Los Angeles, CA, Stephen Williams*, GALVESTON, TX

Introduction: Non-metastatic upper tract urothelial carcinoma (UTUC) is a heterogeneous disease with many treatment options that may lead to wide variation in costs.

Methods: We identified 4,114 patients diagnosed with non-metastatic UTUC from 2004-2013 in the Survival Epidemiology and End Results-Medicare linked population-based database. Patients were stratified into low- or high-risk disease groups.  Total Medicare costs within one year of diagnosis were compared for patients managed with renal preservation (RP) versus radical nephroureterectomy (NU) using inverse probability of treatment-weighted (IPTW) propensity score models.

Results: After risk stratification, 1,027 (25%) and 3,087 (75%) patients were classified into low- vs high-risk UTUC groups and 1,085 (26%) and 3,029 (74%) patients underwent RP and NU, respectively. Median total costs were significantly higher by risk (high vs. low: $141,621 vs. $110,878, p<0.001). Median costs according to categories of services were significantly less for RP vs. NU patients by hospitalization ($22,801 vs. $23,211; Median Difference -$1,369, Hodges-Lehmann (H-L) 95% Confidence Interval (CI), -$2,556 to -$181), office visits ($1,616 vs. $1,874; Median Difference -$238, HL 95% CI, -$340 to -$135), emergency room/critical care ($578 vs. $758; Median Difference -$88, HL 95% CI, -$141 to -$34), consultations ($578 vs. $758; Median Difference -$80, HL 95% CI, -$134 to -$25), and anesthesia ($534 vs. $711; Median Difference -$203; HL 95% CI, -$230 to -$176). The only category which was significantly higher for RP vs. NU was inpatient visits ($1,699 vs. $1,532; Median Difference $152; HL 95% CI, $19 to $286).

Conclusions: Healthcare costs of patients with high-risk UTUC are greater than those of low-risk patients. Median costs were significantly less for RP vs. NU by hospitalization, office visits, emergency room/critical care, consultations, and anesthesia costs. In the absence of data demonstrating superiority of NU over RP, especially for patients with low-risk disease, the increased costs may not be substantiated with equivocal outcomes.

Source of Funding: This study was conducted with the support of a Department of Defense Peer Reviewed Cancer Research Program (PRCRP) Career Development Award (W81XWH1710576) (SBW).  VS is supported by the Veteran’s Affairs Health Services Research and Development Fellowship. KEF is supported by H&H Lee UCLA Surgical Scholars Program. This project was supported by UroGen Pharma.