title: Predictors of costs associated with radical cystectomy for bladder cancer: A population-based retrospective cohort study in the province of Quebec, Canada.
abstract: OBJECTIVE
  There is paucity of studies on the predictors of bladder cancer (BC) management costs. We aimed to determine predictors of costs associated with radical cystectomy (RC) for BC.
  
  
  METHODS
  We conducted a retrospective analysis in a cohort of 2,759 patients who underwent RC for BC between 2000 and 2009. We analyzed predictors of pre-surgery, RC, post-surgery, and total costs. The following variables were considered as potential predictors: age, gender, hospital/surgeon case load, academic hospital, and geo-administrative region. Multivariate linear regression was used to determine predictors.
  
  
  RESULTS
  Predictors of pre-surgery costs were: age (β = 808.64, P < 0.0001) and having surgery in an academic hospital (β = 511.42, P = 0.003). Increased RC costs were associated with age (β = 196.73, P = 0.0006), hospital/surgeon annual load (β = 484.45 and β = 254.21, P < 0.0001, respectively). Having surgery in academic hospitals and geographic region were significant predictors of low RC costs (β = -1085.82 and β = -449.31, P < 0.0001, respectively). Increasing age and the presence of post-operative complications were predictors of high post-operative costs (β = 623.48, β = 5781.44, P = 0.01, respectively), while hospital load was associated with low post-surgery costs (β = -949.79, P < 0.0001).
  
  
  CONCLUSIONS
  Patients' age and surgery performed by high-volume health providers were predictive factors of high RC costs. Low RC costs were associated with surgeries performed in academic hospitals.
authors.affiliation: Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Quebec, Canada.
authors.forename: Fabiano
authors.initials: F
authors.lastname: Santos
authors.affiliation: Department of Urology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Alice
authors.initials: A
authors.lastname: Dragomir
authors.affiliation: Department of Urology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Ahmed S
authors.initials: AS
authors.lastname: Zakaria
authors.affiliation: Department of Urology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.affiliation: Department of Urology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Armen
authors.initials: A
authors.lastname: Aprikian
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D004180:Direct Service Costs; D005260:Female; D017048:Health Care Costs; D017721:Hospital Costs; D061847:Hospitals, High-Volume; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000191:economics; D011237:Predictive Value of Tests; D011792:Quebec; D012189:Retrospective Studies; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000191:economics* / Q000601:surgery*
keywords: bladder cancer; costs; predictors; radical cystectomy