Williams SB, Shan Y, Ray-Zack MD, et al. - Via the Surveillance, Epidemiology, and End Results–Medicare cohort study of 2,963 patients aged 66 to 85 years with a diagnosis of clinical stage T2 to T4a bladder cancer, researchers contrasted the 1-year costs related to trimodal therapy vs radical cystectomy, accounting for survival and intensity effects on total costs. For trimodal therapy vs radical cystectomy, median costs were significantly higher in 90 days, 180 days, and 365 days, respectively. Outpatient care, radiology, medication expenses, and pathology/laboratory costs contributed hugely to the greater costs correlated with trimodal therapy. On the inverse probability of treatment–weighted adjusted analyses, patients who were undergoing trimodal therapy had $136,935 higher mean costs in comparison with radical cystectomy 1 year following diagnosis. In conclusion, among patients with muscle-invasive bladder cancer, in comparison with radical cystectomy, trimodal therapy was related to greater costs. The variations in costs were largely attributed to medication and radiology expenses related to trimodal therapy. Extrapolating cost figures led to nationwide excess spending of $468 million for trimodal therapy in contrast with radical cystectomy for patients who received a diagnosis of bladder cancer in 2017.