Journal article
Cost-Effectiveness of Maintenance bacillus Calmette-Guerin for Intermediate and High Risk Nonmuscle Invasive Bladder Cancer
The Journal of urology, Vol.204(3), pp.442-449
09/01/2020
DOI: 10.1097/JU.0000000000001023
PMID: 32191580
Abstract
Purpose: While guidelines support the use of maintenance bacillus CalmetteGuerin for patients with intermediate and high risk nonmuscle invasive bladder cancer, in an era of bacillus Calmette-Guerin shortage we explored the cost-effectiveness of maintenance bacillus Calmette-Guerin.
Materials and Methods: A Markov model compared the cost-effectiveness of maintenance bacillus Calmette-Guerin to surveillance after induction bacillus Calmette-Guerin for intermediate/high risk nonmuscle invasive bladder cancer from a U.S. Medicare perspective. Five-year oncologic outcomes, toxicity rates and utility values were extracted from the literature. Univariable and multivariable sensitivity analyses were conducted. A willingness to pay threshold of $100,000 per quality adjusted life year was considered cost-effective.
Results: At 5 years mean costs per patient were $14,858 and $13,973 for maintenance bacillus Calmette-Guerin and surveillance, respectively, with quality adjusted life years of 4.046 for both, making surveillance the dominant strategy. On sensitivity analysis full dose and 1/3 dose maintenance bacillus Calmette-Guerin became cost-effective if the absolute reduction in 5-year progression was greater than 2.1% and greater than 0.76%, respectively. On further sensitivity analysis full dose and 1/3 dose maintenance bacillus Calmette-Guerin became cost-effective when maintenance bacillus Calmette-Guerin toxicity equaled surveillance toxicity. In multivariable sensitivity analyses using 100,000 Monte-Carlo microsimulations, full dose and 1/3 dose maintenance bacillus Calmette-Guerin was cost-effective in 17% and 39% of microsimulations, respectively.
Conclusions: Neither full dose nor 1/3 dose maintenance bacillus Calmette-Guerin appears cost-effective for the entire population of patients with intermediate/high risk nonmuscle invasive bladder cancer. These data support prioritizing maintenance bacillus Calmette-Guerin for the subset of patients with high risk nonmuscle invasive bladder cancer most likely to experience progression, in particular those who tolerated induction bacillus CalmetteGuerin well. Overall, our findings support the American Urological Association policy statement to allocate bacillus Calmette-Guerin for induction rather than maintenance therapy during times of bacillus Calmette-Guerin shortage.
Details
- Title: Subtitle
- Cost-Effectiveness of Maintenance bacillus Calmette-Guerin for Intermediate and High Risk Nonmuscle Invasive Bladder Cancer
- Creators
- Vidit Sharma - Mayo ClinicKevin M. Wymer - Department of Urology, Mayo Clinic , Rochester, Minnesota.Bijan J. Borah - Department of Health Services Research, Mayo Clinic, Rochester, MinnesotaChristopher S. Saigal - University of California, Los AngelesMark S. Litwin - University of California, Los AngelesVignesh T. Packiam - Department of Urology, Mayo Clinic , Rochester, Minnesota.R. Houston Thompson - Department of Urology, Mayo Clinic , Rochester, Minnesota.Matthew K. Tollefson - Mayo Clinic in ArizonaR. Jeffrey Karnes - Department of Urology, Mayo Clinic , Rochester, Minnesota.Stephen A. Boorjian - Mayo Clinic in Arizona
- Resource Type
- Journal article
- Publication Details
- The Journal of urology, Vol.204(3), pp.442-449
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1097/JU.0000000000001023
- PMID
- 32191580
- ISSN
- 0022-5347
- eISSN
- 1527-3792
- Number of pages
- 8
- Grant note
- Veteran's Administration Health Services Research and Development fellowship
- Language
- English
- Date published
- 09/01/2020
- Academic Unit
- Urology
- Record Identifier
- 9984320068302771
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