Lower Net Worth Linked to Higher Costs Post Bladder Cancer Treatment

3D rendering of bladder cancer: ©matthieu - stock.adobe.com

Patients with bladder cancer with lower household net worth experienced a greater risk of high-cost inpatient encounters than those with higher household net worth, indicating a disparity in how patients can access and utilize healthcare services when undergoing treatment.¹

A population-based study looked at healthcare utilization costs in the 90 days after radical cystectomy among 141,903 patients with bladder cancer who were commercially insured. A higher household net worth correlated to lower odds of acute inpatient or emergency department encounters and higher odds of office visits.

Moreover, Black patients experienced higher odds of acute inpatient (OR, 1.22; 95% CI, 1.16-1.29) or emergency department encounters (OR, 1.20; 95% CI, 1.14-1.27), while Asian (OR, 0.76; 95% CI, 0.69-0.85) and Hispanic (OR, 0.74; 95% CI, 0.69-0.78; P <.001) had lower odds of an outpatient encounter vs White patients.

“The interactions between race and financial hardship for individuals with bladder cancer mirrors those seen across medicine, with up to 50.3% of Black cancer survivors endorsing financial hardship due to debt or decreased income while White counterparts more commonly reported the ability to access assets such as refinancing/selling a home or using retirement funds to pay for care,” study authors wrote.

Regarding education, patients with less than a 12th grade education had lower odds of an outpatient encounter vs patients with at least a bachelor’s degree (OR, 0.72; 95% CI, 0.54-0.97; P =.03).

“Those undergoing [radical cystectomy] bear both high risk of morbidity (30%–40% risk of readmission) as well as significant costs which may exceed $69,000 healthcare dollars for the individual from the surgical intervention. As a result, the risk of financial toxicity associated with [radical cystectomy] remains high in magnitude relative to financial resources available,” study authors continued.

According to the authors of the study published in Cancer Medicine, radical cystectomy costs can exceed $69,000 healthcare dollars per individual. The 90-day period following a radical cystectomy is associated with follow-up medical encounters, including acute inpatient, emergency department, outpatient, and office visits. In this study, 45.2% of patients reported an acute inpatient encounter, 20.2% an emergency department encounter, 85.1% outpatient, and 85.3% office visit. Only 9.6% of patients reported no follow-up encounters in 90 days following radical cystectomy.

Acute inpatient encounters had the highest average cost with a mean of $24,642.80 for health plan costs and a mean of $1428.24 out-of-pocket costs. Office visits had the lowest health plan costs with a mean of $1126.78, while emergency department visits had the lowest out-of-pocket costs with a mean of $181.88.

A 2020 study investigated the costs of cystectomy-related complications and found that they can present a significant financial burden to patients both immediately after surgery and in the long term.² For patients who received a radical cystectomy, complication-related healthcare costs were $2681 on average in the short term and $1619 in the long-term.

REFERENCES:

1. Washington SL III, Lonergan PE, Odisho AY,et al. Association of household net worth with healthcare costs after radical cystectomy using real-world data. Cancer Med. 2024; 13:e7116. doi:10.1002/cam4.7116

2. Malangone-Monaco E, Wilson K, Diakun D, et al. Cost of cystectomy-related complications in patients with bladder cancer in the United States. Curr Med Res Opin.2020;36(7):1177–1185. doi:10.1080/03007995.2020.1758927