In Reply We appreciate the thoughtful comments by Efstathiou et al and Molitoris and Simone, which highlight the merits as well as limitations of our 2018 study1 comparing radical cystectomy (RC) with trimodal therapy (TMT) according to survival and costs. Cost of cancer care is expected to soar up to $174 billion by 2020 in the United States, with bladder cancer contributing up to $6 billion of those costs.2 While survival and quality-of-life outcomes are important, these outcomes must be balanced by costs of treatment to provide high-value cancer care.
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Williams SB, Kamat AM, Mehta HB. Utility of Bladder-Sparing Therapy vs Radical Cystectomy for Muscle-Invasive Bladder Cancer—Reply. JAMA Surg. Published online November 21, 2018. doi:10.1001/jamasurg.2018.4372
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