Publication:
Regional differences in total hospital costs for radical cystectomy in the United States

dc.contributor.coauthorHoeh, Benedikt
dc.contributor.coauthorFlammia, Rocco Simone
dc.contributor.coauthorHohenhorst, Lukas
dc.contributor.coauthorSorce, Gabriele
dc.contributor.coauthorChierigo, Francesco
dc.contributor.coauthorPanunzio, Andrea
dc.contributor.coauthorTian, Zhe
dc.contributor.coauthorSaad, Fred
dc.contributor.coauthorGallucci, Michele
dc.contributor.coauthorBriganti, Alberto
dc.contributor.coauthorTerrone, Carlo
dc.contributor.coauthorShariat, Shahrokh F.
dc.contributor.coauthorGraefen, Markus
dc.contributor.coauthorAntonelli, Alessandro
dc.contributor.coauthorKluth, Luis A.
dc.contributor.coauthorBecker, Andreas
dc.contributor.coauthorChun, Felix K.H.
dc.contributor.coauthorKarakiewicz, Pierre I.
dc.contributor.departmentKUH (Koç University Hospital)
dc.contributor.departmentSchool of Medicine
dc.contributor.kuauthorTilki, Derya
dc.contributor.schoolcollegeinstituteKUH (KOÇ UNIVERSITY HOSPITAL)
dc.contributor.schoolcollegeinstituteSCHOOL OF MEDICINE
dc.date.accessioned2024-11-09T23:23:27Z
dc.date.issued2023
dc.description.abstractObjectives: To test for regional differences in total hospital costs (THC) across the United States in bladder cancer patients treated with open radical cystectomy (ORC) or robotic-assisted radical cystectomy (RARC). Materials: We relied on the National Inpatient Sample (NIS) database (2016–2019) and stratified RC patients according to census region (Midwest, Northeast, South, West). Primary statistical analyses consisted of THC-trend analyses and multivariable log-link linear regression models, after adjustment for hospital clustering (Generalized Estimating Equation function) and discharge disposition weighting. Finally, sensitivity analysis, relying on most favorable patient cohort, was performed. Results: Of 5280 eligible patients, 1441 (27%), 1031 (20%), 1854 (35%) and 954 (18%) underwent RC in the Midwest, Northeast, South and West, respectively. Median THC was 28,915$ and differed significantly between regions (Midwest: 28,105$; Northeast: 28,886$; South: 26,096$; West: 38,809$; p < 0.001). After stratification between ORC and RARC, highest THC was invariably recorded in the West: ORC 36,137$ vs 23,941–28,850$ and RARC 43,119$ vs 28,425–29,952$ (both p < 0.05). In multivariable log-link linear regression models, surgery in the West was independently associated with higher THC: ORC (Exponent beta [Exp[β]]: 1.39; 95%-CI: 1.32–1.47; p < 0.001) and RARC (Exp[β]: 1.46; 95%-CI: 1.38–1.55; p < 0.001). Results remained unchanged when analyses were refitted in most favorable patient subgroup. Conclusions: Important regional differences in ORC and RARC THC distinguish the West from other United States regions. The THC discrepancy clearly requires closer examination to identify underlying processes that contribute to inflated costs in the West.
dc.description.indexedbyScopus
dc.description.indexedbyPubMed
dc.description.indexedbyWOS
dc.description.openaccessYES
dc.description.publisherscopeInternational
dc.description.sponsoredbyTubitakEuN/A
dc.description.volume48
dc.identifier.doi10.1016/j.suronc.2023.101924
dc.identifier.issn0960-7404
dc.identifier.scopus2-s2.0-85150449038
dc.identifier.urihttps://doi.org/10.1016/j.suronc.2023.101924
dc.identifier.urihttps://hdl.handle.net/20.500.14288/11248
dc.identifier.wos971400300001
dc.keywordsBladder cancer
dc.keywordsComparison
dc.keywordsHealthcare expenditure
dc.keywordsNIS
dc.keywordsPopulation-based
dc.keywordsRadical cystectomy
dc.keywordsTotal hospital costs aged
dc.keywordsArticle
dc.keywordsCharlson comorbidity index
dc.keywordsUnited States
dc.language.isoeng
dc.publisherElsevier
dc.relation.ispartofSurgical Oncology
dc.subjectUrogenital diseases
dc.subjectBladder
dc.subjectUrinary bladder neoplasms
dc.subjectUrinary diversion
dc.subjectUrinary organ
dc.titleRegional differences in total hospital costs for radical cystectomy in the United States
dc.typeJournal Article
dspace.entity.typePublication
local.contributor.kuauthorTilki, Derya
local.publication.orgunit1SCHOOL OF MEDICINE
local.publication.orgunit1KUH (KOÇ UNIVERSITY HOSPITAL)
local.publication.orgunit2KUH (Koç University Hospital)
local.publication.orgunit2School of Medicine
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