Contemporary cost‐effectiveness analysis comparing sequential bacillus Calmette‐Guerin and electromotive mitomycin versus bacillus Calmette‐Guerin alone for patients with high‐risk non–muscle‐invasive bladder cancer. Issue 16 (18th April 2014)

• Record Type: Journal Article
• Authors: Bachir, Bassel G.; Dragomir, Alice; Aprikian, Armen G.; Tanguay, Simon; Fairey, Adrian; Kulkarni, Girish S.; Breau, Rodney H.; Black, Peter C.; Kassouf, Wassim
• Is Part Of: Cancer. Volume 120:Issue 16(2014)
• Page Start: 2424
• Page End: 2431
• Publication Date: 2014-04-18
• Subjects: cost‐effectiveness -- bacillus Calmette‐Guerin (BCG) -- electromotive mitomycin -- sequential therapy -- non‐muscle invasive bladder cancer; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.28731
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : BACKGROUND: Sequential bacillus Calmette‐Guerin (BCG) and electromotive mitomycin (sequential therapy) have been shown in a randomized prospective trial to be superior to therapy with BCG alone in patients with high‐risk non–muscle‐invasive bladder cancer. The objective of the current study was to compare the costs and benefits of these 2 treatment strategies by performing a 5‐year and 10‐year cost‐effectiveness study. METHODS: A Markov model was developed to estimate the incremental cost‐effectiveness ratio over a 5‐year and 10‐year period. Estimates of disease progression, death, and treatment efficacy were obtained from what to the authors' knowledge is the only randomized trial comparing the 2 therapies. Costs included: 1) medical costs (physician fees); 2) drug costs (preparation and instillation); and 3) hospital costs (procedure fees, admission fees, and tests and procedures done during surveillance). Patients were allowed a second course of induction therapy. RESULTS: Sequential therapy was found to be associated with a higher initial material cost for induction and maintenance. The average effectiveness for the patients treated with therapy with BCG alone was 4.39 years with a mean cost of $9236 (95% confidence interval, $9118‐$9345) per patient. The sequential group resulted in an average effectiveness of 4.65 years, with a mean cost of $16, 468 (95% confidence interval, $16, 371‐$16, 527). The 5‐year incremental cost‐effectiveness ratio of sequential versus BCG‐alone therapy was $27, 815 per life‐year gained. The corresponding figure over a 10‐year period was $8618 per life‐year gained. CONCLUSIONS: The results of the current study suggest that sequential therapy is a cost‐effective treatment for patients with high‐risk non–muscle‐invasive bladder cancer. Cancer 2014;120:2424–2431. © 2014 American Cancer Society . Abstract : The authors performed a cost‐effectiveness study comparing sequential therapy with bacillus Calmette‐Guerin alone. The results suggest that sequential therapy is a cost‐effective treatment for patients with high‐risk non–muscle‐invasive bladder cancer.