Regional trends in the cost of transurethral bladder tumor resection in the outpatient and physician office setting.

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465 Background: TURBT is the standard surgical procedure for diagnosis, staging, and initial treatment of non-muscle invasive bladder cancer. This study aimed to identify current geographic trends associated with the use and cost of TURBT in Medicare beneficiaries. Methods: The Medicare Limited Data Set 100% sample of outpatient and 5% sample of carrier claims data from Q1 2019 to Q3 2020 was used for analysis. Patients who underwent TURBT were identified using CPT codes (55234, 52235, 52240). An analysis of variance (ANOVA) test was run comparing the difference in average claim payment amount, average beneficiary payment to physician, and average allowed charge amount between each region (West, Midwest, Northeast, and South). If the ANOVA test found a significant difference between regions, a t-test was run for all combinations of regions. Results: In the outpatient setting, we identified a total of 92,938 TURBT procedures between 2019 and Q3 2020, including 23,039 (Midwest), 19,890 (Northeast), 33,379 (South), and 16,630 (West). The average Medicare claim payment amount was $2,755 overall, $2,566 (Midwest), $2,866 (Northeast), $2,497 (South), and $3,092 (West). Beneficiaries paid an average of $605 in the Midwest, $673 in the Northeast, $572 in the South, and $697 in the West. The average total charge was $7,343, $7,189, $8,510, and $10,028 in the Midwest, Northeast, South, and West respectively. In the outpatient setting, there were no statistical differences for any cost related variables between the four regions. In the physician office setting, we identified 8,035 TURBT between 2019 and Q3 2020. There were 1,776, 1,577, 3,153, and 1,529 TURBT procedures in the Midwest, Northeast, South, and West, respectively. The average Medicare claim cost was $383 (Midwest), $372 (Northeast), $423 (South), and $417 (West). The average total allowed charges on the claim was $415 overall, and $392, $404, $430, and $432 in the Midwest, Northeast, South, and West, respectively. There was a significant statistical difference (p = 0.0154) for the average claim payment amount between the South and the Northeast. The two regions differed in average claim payment amount by $51 (95% CI: $15, $87). There was a significant difference in the average allowed charge amount between the South and Midwest (p = 0.019) and the West and Midwest (p = 0.016). Compared to the South, the Midwest had a lower average charge amount by $37 (95% CI: $9, $66). The West had a higher average charge amount than the Midwest by $40 (95% CI: $12, $68). Conclusions: This analysis demonstrated a significant difference in the cost of TURBT between regions in the physician office setting. The South had a significant higher claim payment amount than the Northeast. The allowed charge amount in the physician office setting for the South and the West were significantly higher than the Midwest.