Outcomes: What drives cost variation for urologic Ca surgery?

The AUA 2018 take-home messages in outcomes also covered topics such as environmental exposures and bladder cancer and onabotulinumtoxinA (Botox) treatment for patients with overactive bladder. The take-homes were presented by Willie Underwood, III, MD, MPH, MSci, of Roswell Park Comprehensive Cancer Center, Buffalo, NY.

• The main driver of variation in cost for prostatectomy is physician services. For nephrectomy, it is post-acute care, and for cystectomy it is index hospitalization. Given limitations in physician-specific measurement, researchers argued that the Centers for Medicare & Medicaid Services should focus on such components in its Merit-based Incentive Payment System.
• Using geo-mapping and spatial analysis of environmental exposures, researchers identified statistically significant clusters of bladder cancer patients in Erie and Niagara counties, New York. Pollutants associated with bladder cancer were present in all these clusters. In a similar nationwide analysis, researchers found a statistical correlation between environmental quality and prostate cancer stage at diagnosis. They theorized that environmental factors could explain variations in outcomes for poor and African-American patients.
• In a statistical analysis, Gleason score at the positive surgical margin was more predictive of recurrence of prostate cancer than the highest Gleason score after robot-assisted radical prostatectomy. The authors concluded that the Gleason score at the margin should appear on the pathology report.
• In a phase IV post-marketing trial, patients with overactive bladder randomized to receive onabotulinumtoxinA (Botox) experienced significantly better improvements in urinary incontinence compared to patients who received a placebo. In another trial, patients receiving onabotulinumtoxinA reported quality of life improvements as early as the first week. The improvements were sustained at least 12 weeks.
• The percentage of underrepresented minorities in urology residencies has held constant in the past 5 years and lags other medical specialties, including other surgical specialties. Improving the representation of minorities in urology residencies could help address disparities in urologic care.