Western region of the US is associated with higher costs for radical cystectomy

Radical cystectomy (RC) surgery in the Western region of the United States was found to be independently associated with higher total hospital costs (THC), according to recent findings published in Surgical Oncology.¹

Median THC in the South was $26,096, followed by $28,105 in the Midwest, $28,886 in the Northeast, and $38,809 in the West

The investigators used data from the National Inpatient Sample (NIS) database to identify 5280 patients with non-metastatic bladder cancer who underwent RC from 2016 to 2019. Patients were stratified by geographic region of their RC surgery based on US Census categories, falling into either the Midwest, Northeast, South, or West regions. THC was the primary outcome of interest.

Of the 5280 eligible patients, 441 (27%) underwent RC in the Midwest, 1031 (20%) in the Northeast, 1854 (35%) in the South, and 954 (18%) in the West. There were no significant differences in median age, Charlson comorbidity index-distribution, in-hospital mortality, overall complication rates, length of stay, and sex distribution among patients in each region cohort (all P > .05).

For all regions, median THC for RC surgery was $28,915. There were significant differences in median THC when data were stratified by each region. Median THC in the South was $26,096, followed by $28,105 in the Midwest, $28,886 in the Northeast, and $38,809 in the West (P < .001). Even after stratifying by year of study, the West exhibited the highest THC among all 4 regions analyzed.

The investigators then stratified RC by open radical cystectomy (ORC) and robot-assisted radical cystectomy (RARC). In total, 3200 patients undergoing ORC were identified. Of those, 852 (27%) underwent ORC in the Midwest, 590 (18%) in the Northeast, 1202 (38%) in the South, and 557 (17%) in the West.

For RARC, 1876 patients were identified. Among those, 562 (30%) underwent surgery in the Midwest, 383 (20%) in the Northeast, 560 (30%) in the South, and 371 (20%) in the West.

For both ORC and RARC, highest THC was recorded in the West. For ORC, the West had a median THC of $36,137, whereas the other regions ranged from $23,941 (South) to $28,850 (Northeast) (P < .05). Data also showed that ORC surgery in the South independently predicted lower THC (P = .006). The median THC for RARC in the West was $43,119, compared with other regions, which ranged from $28,425 (Northeast) to $29,952 (South) (P < .05).

Even when analyses were stratified to fit the most favorable patient subgroup, surgery in the West remained independently associated with higher THC.

References

1. Hoeh B, Flammia RS, Hohenhorst L, et al. Regional differences in total hospital costs for radical cystectomy in the United States. Surg Oncol. Published online March 9, 2023. Accessed March 14, 2023. doi:10.1016/j.suronc.2023.101924.