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Henry Ford Hospital


INTRODUCTION AND OBJECTIVES: Radiation cystitis (RC) is a major cause of morbidity after radiotherapy for pelvic cancers. In the absence of a definite cure, patients may require repeated admissions, undergoing multiple - often morbid - urological procedures. Our aim was to study the inpatient economic burden and healthcare utilization associated with RC in the United States (US).

METHODS: We focused on 13,272 records of adult (age >= 18) patients with a diagnosis of RC within the National Inpatient Sample (NIS) from 2008- 2014. Patients with a concurrent diagnosis of other bladder conditions (n=914) were excluded. Due to a change in NIS sampling methodology in 2012, trend of RC-associated admissions was analyzed for 2012-2014. ICD-9 diagnosis and procedure codes were used to study inpatient procedures performed during admission. Complex survey procedures were used to study the descriptive characteristics of RC patients and the procedures received during admission. Inflation- adjusted cost for each admission and cumulative annual cost of RC-associated admissions were calculated for the study period.

RESULTS: The 12,358 assessable patients represented 61,346 admissions for RC nationally per NIS survey weights. The number of admissions increased gradually from 1681 (weighted 8405) in 2012 to 1803 (weighted 9015) in 2014. Overall 84% of all RC-associated admissions were non-elective. 74% of the patients were males. A vast majority (82%) of the patients had Medicare/Medicaid insurance. The admissions were equally distributed between teaching (49%) and non-teaching (51%) hospitals, however, 90% of the admissions were in hospitals located in urban areas. Any RC-directed procedure code was recorded in 62% admissions. Of these, 3,331 (43%) admissions recorded more than one procedure code. Blood transfusion was the most frequently recorded code (33%), followed by transurethral procedures (28%) and cystoscopy (12.6%). Radical cystectomy was done in 1.3% of the admissions. The median length of stay was 4.4 days (IQR 2.2-8.4).The inflation-adjusted cost per admission was 9207 US dollars (IQR 5275 -17,573) overall, being higher in teaching hospitals (median 9802 vs 8463 US dollars in non-teaching hospitals. The cumulative cost of inpatient treatment of radiation cystitis was 63.5 million US dollars per year, amounting to a total of 952.2 million over the study period.

CONCLUSIONS: The incidence of RC-associated admissions is rising in the US. This disease is a major burden to US healthcare. The awareness of the inpatient economic burden and healthcare utilization associated with RC may have funding implications.

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Admission Rates, Healthcare Utilization, and Economic Burden of Radiation Cystitis (RC) in the United States