Login to Access Video or Poster Abstract: MP54-04
Sources of Funding: None

Introduction

Current studies have failed to show clear long-term differences in oncologic outcomes or quality of life between Ileal Conduit (IC) and neobladder after Radical Cystectomy (RC). However, few studies have assessed cost differences between diversion types. We analyzed the differences in hospital costs during initial hospitalization and readmissions between neobladder and IC in a nationally representative sample.

Methods

The 2013 Nationwide Readmissions Database (NRD) was queried for patients with bladder cancer undergoing RC. Sociodemographic characteristics, Length of Stay (LOS), hospital costs, and causes of readmission were compared between neobladder and IC. Univariable and multivariable logistic regression models were utilized to assess the impact of urinary diversion type on LOS, readmission rates, and hospitals costs. Costs were modeled using the gamma distribution to account for skewness of data.

Results

Among 4,283 patients included in the analysis, 325 (7.5%) underwent neobladder reconstruction with the remainder undergoing IC. Patient’s with a neobladder were younger (mean age 62 years vs. 69, p <0.001), had a lower Charlson Comorbidity Index (CCI) (CCI of 0 – 69%, vs. 47%, p<0.001), private insurance (44% vs. 24%, p <0.001), higher median household income (Top quartile – 35% vs. 24%, p= 0.02), and were more likely to be treated at high volume metropolitan teaching centers (High volume – 54% vs. 33%, p<0.001). Between the two groups, there was no difference in initial hospitalization LOS, readmission rate, readmission LOS, or 90-day mortality. Neobladders were more likely to be readmitted for hydronephrosis (2.7% vs. 0.3%, p < 0.001) and UTI/Pyelonephritis (18.9% vs. 11.4%, p = 0.066) though the latter did not reach statistical significance. Neobladder mean costs were higher for the initial hospitalization and at 30-day and 90 days. At 90-days, neobladders cost on average $14,000 more per patient than IC. On multivariable analysis, neobladder was an independent predictor of increased cost during readmission (OR 3.41, p < 0.001).

Conclusions

Neobladder diversion after RC is more costly compared to IC both during initial admission and at 90-days despite similar LOS and readmission rates. The increased cost of care may be secondary to increased treatment for obstructive and infectious complications. In an era of changing reimbursements, cost of diversion may also need to be considered when selecting diversion type.

Funding

None