Clinical model of lifetime cost of treating bladder cancer and associated complications

Objectives: To estimate the lifetime cost of bladder cancer and the contribution of complications to the total costs. Methods: We reviewed the medical records of a retrospective cohort of 208 patients with bladder cancer who registered at our comprehensive cancer center from 1991 to 1999. We multiplied the number of resources used during management of bladder cancer by their unit charges. We converted charges into costs using the Medicare cost-to-charge ratio and inflated these to 2005 U.S. dollars. We estimated future costs by creating two extreme hypothetical scenarios. In the best-case scenario, we assumed patients with superficial disease developed recurrences at the cohort's mean rate and that patients with muscle-invasive disease were disease free after definitive therapy. Survival was based on the U.S. life expectancy in both cases. In the worst-case scenario, we assumed patients with superficial disease developed muscle-invasive disease and that all patients subsequently died of bladder cancer. Results: The average cost of bladder cancer was $65,158 among the cohort patients. Sixty percent of this cost ($39,393) was associated with surveillance and treatment of recurrences, and 30% ($19,811) was attributable to complications. The lifetime cost of bladder cancer was lower for the worst-case scenario ($99,270) than for the best-case scenario ($120,684). However, a greater proportion of the costs were attributable to complications with the worst-case scenario (43%, $42,290) compared with the best (28%, $34,169). Conclusions: The management of bladder cancer and its associated complications results in a major economic burden. More cost-effective surveillance strategies and approaches for preventing complications are crucial to minimizing the disease's clinical and economic consequences.