Presentation Authors: KC Biebighauser Bens*, Elizabeth Traore, Mohammed Said, Jeffrey Pearl, Louis Aliperti, Mehrdad Alemozaffar, Christopher Filson, Atlanta, GA
Introduction: Perioperative intravesical gemcitabine and mitomycin C (MMC) have similar efficacy in decreasing recurrence after resection of bladder tumors, and gemcitabine is considerably cheaper than MMC. We estimated national cost savings associated with replacement of intravesical MMC with gemcitabine for eligible Medicare beneficiaries undergoing bladder tumor resection (TURBT).
Methods: We retrospectively reviewed TURBT cases (CPT 52224, 52234, 52235, 52240) performed from July 2017 through December 2017 at our institution. Appropriateness for perioperative chemotherapy was based on intraoperative tumor description and clinical factors in line with current guidelines. We extrapolated results to TURBT cases performed for fee-for-service Medicare beneficiaries in 2016. Cost estimates were calculated as if all potential doses of MMC were replaced by gemcitabine across a variety of utilization rates (i.e., actual use, all indicated cases (ideal use), and actual plus ideal (increased use)). We used 2016 Medicare average sales price for typical doses of MMC ($1152.61) and gemcitabine ($64.99). We used recent real-world estimates of 5% of TURBT cases for Medicare beneficiaries receiving intravesical chemotherapy.
Results: Among 114 TURBT cases at our institution, 31 cases (27%) were appropriate for, and received, intravesical MMC. MMC was not indicated and not given for 59 cases (52%). For the remaining cases, MMC was either indicated and not given (13/114, 11%), or not indicated and given (11/114, 10%). We identified 117,108 TURBT cases performed for fee-for-service Medicare beneficiaries in 2016. We extrapolated ideal use at 39% of cases, actual use at 37% of cases, and increased use at 48% of cases. Replacing MMC with gemcitabine would result in annual Medicare savings of $49.2 million with ideal use, $46.9 million with actual use, $60.3 million with increased use, and $6.4 million based on the estimated real-world use of intravesical chemotherapy (Figure).
Conclusions: Increased costs associated with optimizing utilization of perioperative chemotherapy at a national level would be offset by replacing mitomycin-C with gemcitabine.
Source of Funding: American Cancer Society (MSRG-CPHPS for CPF)