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

Authors

  • Bassel G. Bachir MD,

    1. Division of Urology, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
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    • The first 2 authors contributed equally to this article.

  • Alice Dragomir PhD,

    1. Division of Urology, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
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    • The first 2 authors contributed equally to this article.

  • Armen G. Aprikian MD,

    1. Division of Urology, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
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  • Simon Tanguay MD,

    1. Division of Urology, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
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  • Adrian Fairey MD,

    1. Division of Urology, Department of Surgery, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
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  • Girish S. Kulkarni MD,

    1. Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
    2. Institute for Clinical and Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada
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  • Rodney H. Breau MD,

    1. Division of Urology, Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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  • Peter C. Black MD,

    1. Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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  • Wassim Kassouf MD

    Corresponding author
    1. Division of Urology, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
    2. McGill Urology Residency Program Director, McGill University Health Center, Montreal, Quebec, Canada
    • Corresponding author: Wassim Kassouf, MD, Division of Urology, McGill University Health Center, 1650 Cedar Ave, Rm L8-315, Montreal, Quebec H3G 1A4, Canada; Fax: (514) 934-8297; wassim.kassouf@muhc.mcgill.ca

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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.

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