Understanding the Economic Burden of Treating Low-Grade Upper Tract Urothelial Cancer in the United States

Thacker, Kim; Raman, Jay D.; McLean, T; Said, Jack; Oliver, Louisa; Gore, John L.

doi:10.1097/upj.0000000000000161

Cited by 5 publications

(1 citation statement)

References 21 publications

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“…We should highlight that kidney-sparing management itself was identified as a costsaving alternative to radical nephroureterectomy, with USD 252,272 per patient saved in 5 years [25]. Actually, we did not find studies that analyzed the impact of TL from an economic point of view in the setting of UTUC conservative treatment.…”

Section: Limitations and Future Directionsmentioning

confidence: 88%

Endoscopic Conservative Treatment of Upper Urinary Tract Urothelial Carcinoma with a Thulium Laser: A Systematic Review

Candela

Ventimiglia

Solano

et al. 2023

JCM

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Introduction: Thulium lasers (TLs), namely the Thulium fiber laser (TFL) and the Thulium:YAG (Tm:YAG), are being increasingly adopted for the conservative treatment of upper urinary tract urothelial carcinoma (UTUC). However, to date, the real clinical impact of TLs on UTUC management remains not well-characterized. We performed a review of the literature to summarize the current evidence on TLs for UTUC treatment. Materials and Methods: We performed a systematic review in January 2023 using the Embase and Medline online databases, according to the PRISMA recommendations and using the PICO criteria. Outcomes of interest were: (i) to assess the safety and feasibility of TLs in the treatment of UTUC, and (ii) to evaluate the oncological outcomes in terms of tumor recurrence and conservative treatment failure. Moreover, we described TL characteristics and its interaction with soft tissue. Results: a total of 458 articles were screened, and six full texts including 273 patients were identified. All the included studies were retrospective series. Mean patient age ranged from 66 to 73 years. The indication of a conservative treatment was elective and imperative in 21.7–85% and 15–76% of cases, respectively. Laser power settings varied from 5 to 50 W. No intraoperative complications were reported, and all the procedures were successfully performed. The tumor recurrence rate was 17.7–44%, and the indication to radical nephroureterectomy was 3.7–44% during a follow-up of 6–50 months. Most of the postoperative complications were mild and transient, and ureteral strictures were reported in two studies. Major limitations were the retrospective nature of the studies, the small sample sizes, and the short follow-up. Conclusions: TL is an effective and safe technology for endoscopic UTUC treatment. However, current available literature lacks prospective and multicentric studies with large population sizes and long-term follow-up.

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Section: Limitations and Future Directionsmentioning

confidence: 88%

Endoscopic Conservative Treatment of Upper Urinary Tract Urothelial Carcinoma with a Thulium Laser: A Systematic Review

Candela

Ventimiglia

Solano

et al. 2023

JCM

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Conservative Treatment of Upper Urinary Tract Urothelial Carcinoma: Referee

Grobet-Jeandin

Pinar

Rouprêt

2021

European Urology Open Science

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Treatment Patterns, Outcomes, and Costs Associated With Localized Upper Tract Urothelial Carcinoma

Fero

Shan

Lec

et al. 2021

JNCI Cancer Spectrum

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Background Upper tract urothelial carcinoma (UTUC) is a heterogeneous disease that presents a clinical management challenge for the urologic surgeon. We assessed treatment patterns, costs, and survival outcomes among patients with non-metastatic UTUC. Methods We identified 4,114 patients diagnosed with non-metastatic UTUC from 2004-2013 in the Survival Epidemiology and End Results-Medicare linked population-based database. Patients were stratified into low- or high-risk disease groups. Median total costs from 30 days prior to diagnosis through 365 days after diagnosis were compared between groups. Overall and cancer-specific survival were evaluated using Cox proportional hazards regression. All statistical tests were 2-sided. Results After risk stratification, 1,027 (24.9%) and 3,087 (75.0%) patients were classified into low- vs high-risk UTUC groups. Most patients underwent at least one surgical intervention (95.1%); 68.4% underwent at least one endoscopic intervention. Patients diagnosed with high- vs low-risk UTUC were more likely to undergo nephroureterectomy (83.6% vs 72.0%, P<0.001); few patients with low-risk disease were exclusively managed endoscopically (16.9%). At 365 days after diagnosis, costs of care for high- vs low-risk UTUC was statistically significantly higher ($108,520 vs $91,233; median difference $16,704, 95% confidence interval [CI] = $11,619 to $21,778, P <0.001). Those with high-risk UTUC had worse cancer-specific and overall survival compared with patients with low-risk UTUC (cancer-specific survival hazard ratio = 4.14, 95% CI = 3.19 to 5.37; overall survival hazard ratio = 1.78, 95% CI = 1.62 to 1.96). Conclusions UTUC continues to be managed primarily with nephroureterectomy, regardless of risk stratification, and patients with high-risk UTUC have worse overall and cancer-specific survival. Substantial costs are associated with management of low- and high-risk UTUC, with the latter being more costly up to 1 year from diagnosis.

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Understanding the Economic Burden of Treating Low-Grade Upper Tract Urothelial Cancer in the United States

Cited by 5 publications

References 21 publications

Endoscopic Conservative Treatment of Upper Urinary Tract Urothelial Carcinoma with a Thulium Laser: A Systematic Review

Endoscopic Conservative Treatment of Upper Urinary Tract Urothelial Carcinoma with a Thulium Laser: A Systematic Review

Conservative Treatment of Upper Urinary Tract Urothelial Carcinoma: Referee

Treatment Patterns, Outcomes, and Costs Associated With Localized Upper Tract Urothelial Carcinoma

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