Abstract
Introduction
Non-muscle-invasive bladder cancer (NMIBC) is a biologically heterogeneous disease and is one of the most expensive malignancies to treat on a per patient basis. In part, this high cost is attributed to the need for long-term surveillance. We sought to perform an economic analysis of surveillance strategies to elucidate cumulative costs for the management of NMIBC.
Methods
A Markov model was constructed to determine the average 5-year costs for the surveillance of patients with NMIBC. Patients were stratified into low, intermediate, and high-risk groups based on the EORTC risk calculator to determine recurrence and progression rates according to each category. The index patient was a compliant 65-year-old male. A total of four health states were utilized in the Markov model: no evidence of disease, recurrence, progression and cystectomy, and death.
Results
Cumulative costs of care over a 5-year period were $52,125 for low-risk, $146,250 for intermediate-risk, and $366,143 for high-risk NMIBC. The primary driver of cost was progression to muscle-invasive disease requiring definitive therapy, contributing to 81% and 92% of overall cost for intermediate- and high-risk disease. Although low-risk tumors have a high likelihood of 5-year recurrence, the overall cost contribution of recurrence was 8%, whereas disease progression accounted for 71%.
Conclusion
Although protracted surveillance cystoscopy contributes to the expenditures associated with NMIBC, progression increases the overall cost of care across all three patient risk groups and most notably for intermediate- and high-risk disease patients.
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MM: project development, data analysis, and manuscript writing and editing. YW: data analysis, data management, and manuscript writing and editing. JS: data analysis and manuscript writing and editing. WST: data analysis and manuscript writing and editing. MJH: manuscript review and editing. MAP: manuscript review and editing. Q-DT: manuscript review and editing. GS: manuscript review and editing. ASK: manuscript review and editing. SLC: project development, data analysis, and manuscript writing and editing.
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Dr. Sonpavde has the following disclosures: Consultant for Bayer, Sanofi, Pfizer, Novartis, Eisai, Janssen, Amgen, Astrazeneca, Merck, Genentech, EMD Serono, Agensys/Astellas; Research support to institution from Bayer, Celgene, Boehringer-Ingelheim, Merck, Pfizer, Sanofi, Janssen; Author for Uptodate; Speaker fees from Clinical Care Options, Physicians Education Resource (PER), Research to Practice (RTP), Onclive. This research did not involve human participants or animals.
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Mossanen, M., Wang, Y., Szymaniak, J. et al. Evaluating the cost of surveillance for non-muscle-invasive bladder cancer: an analysis based on risk categories. World J Urol 37, 2059–2065 (2019). https://doi.org/10.1007/s00345-018-2550-x
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DOI: https://doi.org/10.1007/s00345-018-2550-x