Jinhai Huo1, Yiyi Chu2, Karim Chamie3, Marc C Smaldone4, Stephen A Boorjian5, Jacques G Baillargeon6, Yong-Fang Kuo7, Preston Kerr8, Padraic O'Malley9, Eduardo Orihuela8, Douglas S Tyler10, Stephen J Freedland11, Sharon H Giordano2, Raghu Vikram12, Ashish M Kamat13, Stephen B Williams14. 1. Department of Health Services Research, Management and Policy, The University of Florida, Gainesville, FL. 2. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX. 3. Department of Urology, University of California Los Angeles, Los Angeles, CA. 4. Department of Urology, Fox Chase Cancer Center, Philadelphia, PA. 5. Department of Urology, Mayo Clinic, Rochester, MN. 6. Division of Epidemiology, Department of Medicine, Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX. 7. Division of Biostatistics, Department of Medicine, Sealy Center on Aging, Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX. 8. Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX. 9. Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada. 10. Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston, TX. 11. Department of Urology, Cedars Sinai Medical Center, Los Angeles, CA. 12. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX. 13. Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX. 14. Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX. Electronic address: stbwilli@utmb.edu.
Abstract
BACKGROUND: The purpose of this study was to examine temporal nationwide utilization patterns and predictors for use of positron emission tomography/computed tomography (PET/CT) in comparison with magnetic resonance imaging (MRI) and computed tomography (CT) among patients diagnosed with bladder cancer. MATERIALS AND METHODS: A total of 36,855 patients aged 66 years or older diagnosed with clinical stage TI-IV, N0M0 bladder cancer from 2004 to 2011 were analyzed. We used multivariable logistic regression analyses to discern factors associated with receipt of imaging within 12 months from diagnosis. The Cochran-Armitage test for trend was used to determine changes in the proportion of patients receiving imaging after cancer diagnosis. RESULTS: Independent of clinical stage, there was marked increase in use of PET/CT throughout the study period (2011 vs. 2004: odds ratio, 17.55; 95% confidence interval, 10.14-30.38; P < .001). Although use of CT imaging remained stable during the study period, there was significantly decreased utilization of MRI (odds ratio, 0.60; 95% confidence interval, 0.49-0.75; P < .001) in 2011 versus 2004. The mean incremental cost of PET/CT versus CT and MRI was $1040 and $612 (in 2016 dollars), respectively. Extrapolating these findings to the patients with bladder cancer in the United States results in excess spending of $11.6 million for PET/CT imaging. CONCLUSION: We identified rapid adoption of PET/CT imaging independent of clinical stage, resulting in excess national spending of $11.6 million for this imaging modality alone. Further value-based research discerning the clinical versus economic benefits of advanced imaging among patients with bladder cancer are needed.
BACKGROUND: The purpose of this study was to examine temporal nationwide utilization patterns and predictors for use of positron emission tomography/computed tomography (PET/CT) in comparison with magnetic resonance imaging (MRI) and computed tomography (CT) among patients diagnosed with bladder cancer. MATERIALS AND METHODS: A total of 36,855 patients aged 66 years or older diagnosed with clinical stage TI-IV, N0M0 bladder cancer from 2004 to 2011 were analyzed. We used multivariable logistic regression analyses to discern factors associated with receipt of imaging within 12 months from diagnosis. The Cochran-Armitage test for trend was used to determine changes in the proportion of patients receiving imaging after cancer diagnosis. RESULTS: Independent of clinical stage, there was marked increase in use of PET/CT throughout the study period (2011 vs. 2004: odds ratio, 17.55; 95% confidence interval, 10.14-30.38; P < .001). Although use of CT imaging remained stable during the study period, there was significantly decreased utilization of MRI (odds ratio, 0.60; 95% confidence interval, 0.49-0.75; P < .001) in 2011 versus 2004. The mean incremental cost of PET/CT versus CT and MRI was $1040 and $612 (in 2016 dollars), respectively. Extrapolating these findings to the patients with bladder cancer in the United States results in excess spending of $11.6 million for PET/CT imaging. CONCLUSION: We identified rapid adoption of PET/CT imaging independent of clinical stage, resulting in excess national spending of $11.6 million for this imaging modality alone. Further value-based research discerning the clinical versus economic benefits of advanced imaging among patients with bladder cancer are needed.
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