Introduction:

Bladder cancer is the second most common malignancy of the genitourinary tract with approximately 80,00 new cases diagnosed in 2018. Roughly one-quarter of patients with urothelial carcinoma of the bladder are initially diagnosed with or eventually progress to muscle-invasive disease.  Muscle invasive bladder cancer (MIBC) is a morbid condition often requiring multimodal therapy with significant clinical and economic impact. The Enhanced Recovery After Surgery (ERAS) protocol has be adapted to radical cystectomy (RC) and urinary diversion and has been demonstrated to improve patient outcomes while potentially minimizing cost. In this study, we aim to describe the cost of RC with and without implementation of ERAS protocol. 
 

Methods:

All patients who underwent RC at our institution between January 2016 and June 2019 were retrospectively reviewed. Financial identification numbers (FINs) were processed by our financial office and cost was divided into total and variable cost for each patient. Patient demographics, cost of RC and subsequent hospital stay were collected and analyzed.  Costs were adjusted to 2019 US dollars using the Producer Priced Index.  Analysis was run on variable costs using independent samples t-tests between non-ERAS and ERAS cohorts. 

Results:

Figure 1 displays the patient characteristics and cost analysis.  There was no significant difference in total variable cost between the total ERAS cohort ($604) and the male ERAS sub-cohort ($1,989) compared to their non-ERAS counterparts (p=0.75, p=0.24) Across all patients, ERAS patients had less costs associated with blood bank ($142) and all therapy modalities ($123) compared to the non-ERAS cohort costs of blood bank ($366) and therapy ($182), (p<0.05).  In the male sub-cohort, ERAS patients had less average cost for anesthesia ($880 vs. $1,087, p=0.002), blood bank ($319 vs. $72, 0.0001), ICU ($77 vs. $540, p=0.025), radiology ($129 vs. $82, p=0.017), respiratory ($181 vs. $74, p=0.048), and therapy ($183 vs. $109, p=0.002) compared to non-ERAS male patients. 

Conclusion:

Male patients who underwent RC with implementation of ERAS were found to have lower costs than their non-ERAS counterparts in certain care categories. Further studies with larger cohorts are necessary to help understand variances in cost patterns when implementing an ERAS protocol.

Funding: N/A