Trimodal therapy vs. radical cystectomy for muscle-invasive bladder cancer: A Canadian cost-effectiveness analysis

Authors

  • Ronald Kool Division of Urology, McGill University Health Centre, McGill University, 1001 Decarie Blvd, D02.7210, Montreal, QC H4A 3J1, Canada https://orcid.org/0000-0001-7471-6456
  • Ivan Yanev Division of Urology, McGill University Health Centre, McGill University, 1001 Decarie Blvd, D02.7210, Montreal, QC H4A 3J1, Canada
  • Tarek Hijal Division of Radiation Oncology, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC H4A 3J1, Canada
  • Marie Vanhuyse Division of Medical Oncology, McGill University Health Centre, McGill University, 1001 Decarie Blvd, D02.7210, Montreal, QC H4A 3J1, Canada
  • Fabio L. Cury Division of Radiation Oncology, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC H4A 3J1, Canada
  • Luis Souhami Division of Radiation Oncology, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC H4A 3J1, Canada
  • Wassim Kassouf Division of Urology, McGill University Health Centre, McGill University, 1001 Decarie Blvd, D02.7210, Montreal, QC H4A 3J1, Canada
  • Alice Dragomir Division of Urology, McGill University Health Centre, McGill University, 1001 Decarie Blvd, D02.7210, Montreal, QC H4A 3J1, Canada

DOI:

https://doi.org/10.5489/cuaj.7430

Keywords:

Bladder Cancer, Cost-Benefit Analysis, Surgery, Radiotherapy

Abstract

Introduction: Trimodal therapy (TMT) is a suitable alternative to neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) for patients with muscle-invasive bladder cancer (MIBC). In this study, we conducted a cost-effectiveness evaluation of RC±NAC vs. TMT for MIBC in the universal and publicly funded Canadian healthcare system.

Methods: We developed a Markov model with Monte-Carlo microsimulations. Rates and probabilities of transitioning within different health states (e.g., cure, locoregional recurrence, distant metastasis, death) were input in the model after a scoped literature review. Two main scenarios were considered: 1) academic center; and 2) populational-level. Results were reported in life-years gained (LYG), quality-adjusted life years (QALY), and incremental cost-effectiveness ratio (ICER). A sensitivity analysis was performed.

Results: A total of 20 000 patients were simulated. For the academic center model, TMT was associated with increased effectiveness (both in LYG and QALY) at a higher cost compared to RC±NAC at five and 10 years. This resulted in an ICER of $19 746/QALY per patient undergoing the TMT strategy at 10 years of followup. For the populational-level model, RC±NAC was associated with higher effectiveness at 10 years, with an ICER of $3319/QALY per patient. This study was limited by heterogeneity within the studies used to build the model.

Conclusions: In this study, TMT performed in academic centers was cost-effective compared to RC±NAC, with higher effectiveness at a higher cost. On the other hand, RC±NAC was considered cost-effective compared to TMT at the population level. Further studies are needed to confirm these results.

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Published

2022-01-27

How to Cite

Kool, R., Yanev, I., Hijal, T., Vanhuyse, M., L. Cury, F., Souhami, L., Kassouf, W., & Dragomir, A. (2022). Trimodal therapy vs. radical cystectomy for muscle-invasive bladder cancer: A Canadian cost-effectiveness analysis. Canadian Urological Association Journal, 16(6), 189–98. https://doi.org/10.5489/cuaj.7430

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Section

Original Research