Abstract
BACKGROUND: The aim of this study was to elucidate the disparities in life expectancy, loss-of-life expectancy, and lifetime medical expenditure between sexes in patients with bladder cancer. METHODS: In this retrospective study, we used three Taiwanese databases to analyze the data of patients diagnosed with bladder cancer between 2008 and 2019. Patients aged <30 years or >90 years were excluded. Survival and lifetime costs were estimated using the Kaplan-Meier and semiparametric methods. Subgroup analyses were performed to examine the effects of cancer stage, age, and factors such as hemodialysis on patient outcomes and costs. RESULTS: This study included 30,390 new diagnoses of bladder cancer. Disparities in loss-of-life expectancy between men and women were observed in both non-muscle-invasive bladder cancer (3.17 [0.55] years for men vs. 7.14 [0.76] years for women) and muscle-invasive bladder cancer (8.86 [0.43] years for men vs. 10.64 [0.63] years for women). Carcinoma in situ revealed its profound impact, with the associated loss-of-life expectancy mirroring those of advanced stages (combined sex carcinoma in situ: 8.58 years, stage 2 men: 9.48 years, stage 2 women: 9.53 years). The cost per life-year showed a marked difference, especially for non-muscle-invasive bladder cancer ($4,631 for men vs. $7,636 for women) and muscle-invasive bladder cancer ($6,033 for men vs. $7,753 for women). Hemodialysis accounted for a significant portion of these costs, with hemodialysis rates of 4.6% in men and 18.5% in women. CONCLUSIONS: Women have a higher prevalence of high-grade histopathology and an extended duration of hemodialysis, culminating in inferior outcomes in non-muscle-invasive bladder cancer and muscle-invasive bladder cancer and augmented costs, compared with men. The role of hemodialysis and the carcinoma in situ stage highlights the need for vigilant monitoring and early aggressive treatment strategies.