Understanding the Economic Burden of Treating Low-Grade Upper Tract Urothelial Cancer in the United States

Introduction:Low grade upper tract urothelial cancer is an uncommon urothelial tumor for which treatment involves multiple ureteroscopic interventions and potentially radical nephroureterectomy. Given the burden of these procedures, there is growing interest in determining how the utilization, complications and morbidities associated with treatment contribute to the burden of care for upper tract urothelial cancer. The aim of this study was to conduct a systematic literature review to understand the economic burden of treating low grade upper tract urothelial cancer.Methods:The systematic literature review captured publications from January 1, 2009 to March 11, 2019 in MEDLINE®, Embase®, Evidence-Based Medicine Reviews, PsycINFO and EconLit. Conference proceedings from 7 different conferences were also searched.Results:We identified 15 studies that reported on the economic burden associated with treatment interventions in upper tract urothelial cancer. Treatment costs associated with radical nephroureterectomy were the greatest cost component contributing to expenditures including initial procedural costs (ranging from $11,793 to $23,235 per patient), readmission/retreatment costs ($31,697 per patient) and long-terms costs up to 5 years associated with end stage renal disease and chronic kidney disease ($41,474 to $385,464 per patient). Kidney-sparing management was identified as a cost saving alternative to radical nephroureterectomy, with $252,272 per patient saved through 5 years.Conclusions:The economic burden of low grade upper tract urothelial cancer is high due to costs incurred by patient comorbidities, multiple episodes of care and complications associated with radical nephroureterectomy. Therefore, there is a need for a paradigm shift towards cost-effective, minimally invasive, kidney-sparing treatments.