Artikel
Cost-effectiveness-analysis of different treatment modalities in BCG unresponsive non-muscle invasive bladder cancer (NMIBC)
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Autoren
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Constantin Rieger
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
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J. Schlüchtermann
- Faculty of Law, Business and Economics, University of Bayreuth, Bayreuth, Germany
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L. Kastner
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
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E. Sturz
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
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David Pfister
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
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Axel Heidenreich
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
| Veröffentlicht: | 26. März 2024 |
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Gliederung
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Introduction: Bladder cancer (BC) has the highest lifetime treatment costs among cancer entities due to repetitive and frequent diagnostic interventions as well as elaborate therapy. Most BCs are non-muscle invasive and depending on risk stratification are treated with BCG (Bacillus Calmette-Guérin). Radical cystectomy (RC) is the standard of care (SOC) in BCG-refractory NMIBC and is associated with a significant health-related quality-of-life burden. Recently, promising results have been published on Gemcitabine/Docetaxel, Pembrolizumab, and Hyperthermic Intravesical Chemotherapy (HIVEC) as salvage therapy options trying to increase the rate of bladder preservation. Here, we performed a cost-effectiveness-analysis of those treatment modalities.
Methods: We developed a Markov model from a payer’s perspective drawing on clinical data of single-arm trials testing intravesical Gemcitabine/Docetaxel and Pembrolizumab in BCG-unresponsive NMIBC (Gemcitabine/Docetaxel and Pembrolizumab) as well as clinical data from patients receiving HIVEC (n=29) as intravesical salvage-chemotherapy at our urooncologic center in cologne. Costs were simulated utilizing a non-commercial DRG-grouper, utilities were derived from comparable cost-effectiveness studies. We used a Monte-Carlo Simulation to identify the optimal treatment, comparing the incremental cost effectiveness ratios (ICER) at a willingness-to-pay threshold of 50,000 €/QALY.
Results: Over a horizon of 10 years, Gemcitabine/Docetaxel, HIVEC, and Pembrolizumab were associated with costs of 48,353, 64,438, and 204,580 €, as well as a gain of QALYs of 6.16, 6.48, and 6.00, resulting in an ICER of 26,482, 42,567, and 184,533 € respectively, in comparison to RC with total costs of 21,871 € and a gain of QALYs of 5.01. Monte-Carlo Simulation identified HIVEC as the treatment of choice under assumption of a WTP <50,000 €. QALY gains under Gemcitabine/Docetaxel and HIVEC in particular were mainly driven by bladder preservation and the low rate of progression.
Conclusion: Considering a WTP <50,000 €/QALY, Gemcitabine/Docetaxel and HIVEC are highly cost-effective therapeutic options in BCG-refractory bladder cancer, while RC remains the cheapest option. At its current price, Pembrolizumab would only be cost-effective assuming a price reduction of at least 70%.
