You have accessJournal of UrologyBladder Cancer: Invasive III1 Apr 2018MP41-06 IMPLICATIONS OF NEOADJUVANT CHEMOTHERAPY ON COST AND OUTCOMES IN MUSCLE INVASIVE BLADDER CANCER Timothy Clinton, Solomon Woldu, Oner Sanli, Richard Wang, Louis Gianni, Ganesh Raj, Arthur Sagalowsky, Vitaly Margulis, and Yair Lotan Timothy ClintonTimothy Clinton More articles by this author , Solomon WolduSolomon Woldu More articles by this author , Oner SanliOner Sanli More articles by this author , Richard WangRichard Wang More articles by this author , Louis GianniLouis Gianni More articles by this author , Ganesh RajGanesh Raj More articles by this author , Arthur SagalowskyArthur Sagalowsky More articles by this author , Vitaly MargulisVitaly Margulis More articles by this author , and Yair LotanYair Lotan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1293AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) is the standard of care for muscle invasive bladder cancer (MIBC); however utilization has been limited due to concerns for toxicity and marginal improvement in overall survival (OS). It is reported that NAC does not affect perioperative complications and we aimed to evaluate our experience and determine impact on cost of MIBC management. METHODS Retrospective review of RC performed for cT2-T4N0M0 bladder cancer from 2012-2016. Detailed baseline clinicopathologic factors were abstracted including comorbidity and hematologic parameters. Patients were stratified according to receipt of NAC, and perioperative and postoperative complications were identified. Clinical outcomes were correlated with direct costs in patients who received all oncologic care at our institution. Pre-RC cost included the cost of NAC and associated complications, RC costs included hospitalization and associated complications, and post-RC cost included readmissions/complications within 3 months. RESULTS 172 patients were pathologically qualified for NAC and 53% (n=91) received NAC. Mean follow-up was 21 months. In those patients undergoing RC alone (n=81), 62% had a clinical contraindication. There were significant patient differences based on receipt of NAC (Table); in addition to differences in including preoperative hematologic parameters, and comorbidity status, patients receiving NAC were younger, less likely to be current smokers, undergo orthotopic urinary diversion, and have non-organ confined disease. Patients receiving NAC were also more likely to experience a grade 3+ complication after RC (28% vs 15%, p=0.02), although there was no difference in blood loss, length of stay, or readmission rates within 3 months. The overall costs of care was significantly higher for those who received NAC ($36,680 vs. $25,338, p<0.01) with the main drivers being increased cost of NAC and RC + hospitalization. OS was significantly improved in those receiving NAC (Figure, p=0.04). CONCLUSIONS NAC was associated with improved OS, however we also noted a higher cost at the time of RC and complication rates in patients receiving NAC. Further analysis of downstream costs, including need for expensive salvage therapies, is warranted to determine the cost-effectiveness of NAC. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e529-e530 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Timothy Clinton More articles by this author Solomon Woldu More articles by this author Oner Sanli More articles by this author Richard Wang More articles by this author Louis Gianni More articles by this author Ganesh Raj More articles by this author Arthur Sagalowsky More articles by this author Vitaly Margulis More articles by this author Yair Lotan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...