Advertisement

Costing Urologic Complications Following Pelvic Radiation Therapy

      Objectives

      To describe patients presenting with urologic complications following pelvic radiation therapy and estimate the financial costs incurred in their treatment.

      Patients and methods

      In the year ending June 2018, all urology admissions at Royal Newcastle Centre were reviewed for diagnostic codes pertaining to urethral or ureteric strictures, cystitis, and haematuria. Presentations were complications following radiotherapy if a diagnosis of radiation cystitis or stricture was recorded, and there was relevant prior radiotherapy.
      The Independent Hospital Pricing Authority's National Weighted Activity Unit (NWAU) 2018 calculators, admission data and the National Efficient Price were used to estimate costs of care. HNELHD HREC granted ethics approval (AU201808-10).

      Results

      Complications following radiotherapy accounted for 65 admissions in 53 discrete patients, accounting for 206 bed days and 3.7% of the 1748 total urology admissions in 1 year. The majority (86%) of admissions had at least 1 operation. Mean time since radiotherapy was 7 years (range 1-30). Mean number of operations related to complications following radiotherapy was 3 (range 0-11). Readmissions were more frequent (mean 1.9 admissions/year) than other urology inpatients (mean 1.3 admissions/year, P < .001). Mean NWAU18 value was 4.12 (range 2-8.3). Admission and procedure costs were AUD $1,346,700, secondary malignancies were $9,000 and emergency department costs were $45,864 for a combined total of $1,401,591.

      Conclusion

      Patients requiring urological admission with complications following radiotherapy use more resources, stay for longer, have more operations and return more frequently than other urology patients. Conservative estimates of cost $25,900 per patient in the study year alone.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hamdy FC
        • Donovan JL
        • Lane JA
        • et al.
        10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer.
        N Engl J Med. 2016; 375: 1415-1424
        • Jones MP
        • Hruby G
        • Metser U
        • et al.
        FDG-PET parameters predict for recurrence in anal cancer – results from a prospective, multicentre clinical trial.
        Radiation Oncology. 2019; 14: 140
        • Song YP
        • McWilliam A
        • Hoskin PJ
        • Choudhury A
        Organ preservation in bladder cancer: an opportunity for truly personalized treatment.
        Nat Rev Urol. 2019; 16: 511-522
        • Sauer R
        • Liersch T
        • Merkel S
        • et al.
        Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years.
        J Clin Oncol. 2012; 30: 1926-1933
        • Landoni F
        • Maneo A
        • Colombo A
        • et al.
        Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer.
        The Lancet. 1997; 350: 535-540
        • Browne C
        • Davis NF
        • Mac Craith E
        • et al.
        A rarrative review on the pathophysiology and management for radiation cystitis.
        Adv Urol. 2015; 2015346812
        • Bennett MH
        • Feldmeier J
        • Hampson NB
        • Smee R
        • Milross C
        Hyperbaric oxygen therapy for late radiation tissue injury.
        Cochrane Database Syst Rev. 2016; 4 (CD005005)
        • Hofer MD
        • Gonzalez CM
        Management of radiation-induced urethral strictures.
        Transl Androl Urol. 2015; 4: 66-71
        • Orchard J
        • Tward JD
        • Lenherr S
        • Hotaling JM
        • Brant WO
        • Myers JB
        Surgical management of ureteral strictures arising from radiotherapy for prostate cancer.
        Urol Case Rep. 2016; 6: 47-49
        • Chrouser KL
        • Leibovich BC
        • Sweat SD
        • et al.
        Urinary fistulas following external radiation or permanent brachytherapy for the treatment of prostate cancer.
        J Urol. 2005; 173: 1953-1957
        • Dracham CB
        • Shankar A
        • Madan R
        Radiation induced secondary malignancies: a review article.
        Radiat Oncol J. 2018; 36: 85-94
        • Wallis CJ
        • Mahar AL
        • Choo R
        • et al.
        Second malignancies after radiotherapy for prostate cancer: systematic review and meta-analysis.
        BMJ. 2016; 352: i851
        • Ng M
        • Brown E
        • Williams A
        • Chao M
        • Lawrentschuk N
        • Chee R
        Fiducial markers and spacers in prostate radiotherapy: current applications.
        BJU Int. 2014; 113: 13-20
        • Council of Australian Governments
        National Health Reform Agreement.
        COAG. 2011
        • Australian Government Productivity Commission
        Efficiency in health.
        Productivity commission. Commonwealth of Australia, 2015
        • Basto M
        • Sathianathen N
        • Te Marvelde L
        • et al.
        Patterns-of-care and health economic analysis of robot-assisted radical prostatectomy in the Australian public health system.
        BJU Int. 2016; 117: 930-939
        • Hennessey DB
        • Fojecki GL
        • Papa NP
        • Lawrentschuk N
        • Bolton D
        Single-use disposable digital flexible ureteroscopes: an ex vivo assessment and cost analysis.
        BJU Int. 2018; 121: 55-61
        • Independent Hospital Pricing Authority
        NWAU Calculator 2017-18.
        IHPA. 2019
        • Ma JL
        • Hennessey DB
        • Newell BP
        • Bolton DM
        • Lawrentschuk N
        Radiotherapy-related complications presenting to a urology department: a more common problem than previously thought?.
        BJU Int. 2018; 121: 28-32
        • Wang C
        • King CR
        • Kamrava M
        • et al.
        Pattern of solid and hematopoietic second malignancy after local therapy for prostate cancer.
        Radiother Oncol. 2017; 123: 133-138
        • Koh W-J
        • Greer BE
        • Abu-Rustum NR
        • et al.
        Cervical Cancer. 2013; 11: 320
        • Benson AB
        • Venook AP
        • Al-Hawary MM
        • et al.
        Anal carcinoma, Version 2.2018.
        NCCN Clin Pract Guide Oncol. 2018; 16: 852
        • Kneebone A
        • Fraser-Browne C
        • Delprado W
        • et al.
        A phase III multi-centre randomised trial comparing adjuvant versus early salvage radiotherapy following a radical prostatectomy: results of the TROG 08.03 and ANZUP “RAVES” Trial.
        Int J Radiat Oncol. 2019; 105: S37-S38
        • Weerakoon M
        • Papa N
        • Lawrentschuk N
        • et al.
        The current use of active surveillance in an Australian cohort of men: a pattern of care analysis from the Victorian Prostate Cancer Registry.
        BJU Int. 2015; 115: 50-56