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

Cancer. 2014 Aug 15;120(16):2424-31. doi: 10.1002/cncr.28731. Epub 2014 Apr 18.

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.

Keywords: bacillus Calmette-Guerin (BCG); cost-effectiveness; electromotive mitomycin; non-muscle invasive bladder cancer; sequential therapy.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / economics*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • BCG Vaccine / administration & dosage
  • BCG Vaccine / economics*
  • Canada
  • Combined Modality Therapy
  • Cost-Benefit Analysis
  • Humans
  • Immunotherapy, Active / economics
  • Immunotherapy, Active / methods
  • Markov Chains
  • Mitomycin / administration & dosage
  • Mitomycin / economics*
  • Models, Economic*
  • Monte Carlo Method
  • Randomized Controlled Trials as Topic
  • Treatment Outcome
  • United Kingdom
  • United States
  • Urinary Bladder Neoplasms / drug therapy
  • Urinary Bladder Neoplasms / economics
  • Urinary Bladder Neoplasms / therapy*

Substances

  • BCG Vaccine
  • Mitomycin