Abstract
BackgroundLimited evidence exists regarding the cost and health-related quality of life (HRQoL) effects of non–muscle-invasive bladder cancer (NMIBC) recurrence and progression to muscle-invasive bladder cancer (MIBC). We examined these effects using evidence from a recent randomized control trial.Material and MethodsThe costs and HRQoL associated with bladder cancer were assessed using data from the BOXIT trial (bladder COX-2 inhibition trial; n = 472). The cost and HRQoL effects from clinical events were estimated using generalized estimating equations. The costs were derived from the recorded resource usage and UK unit costs. HRQoL was assessed using the EQ-5D-3L and reported UK preference tariffs. The events were categorized using the TMN classification.ResultsCases of grade 3 recurrence and progression were associated with statistically significant HRQoL decrements (−0.08; 95% confidence interval [CI], −0.13 to −0.03; and −0.10; 95% CI, −0.17 to −0.03, respectively). The 3-year average cost per NMIBC patient was estimated at £8735 (95% CI, 8325-9145). Cases of grade 1, 2, and 3 recurrence were associated with annual cost effects of £1218 (95% CI, 403-2033), £1677 (95% CI, 920-2433), and £3957 (95% CI, 2332-5583), respectively. Progression to MIBC was associated with an average increase in costs of £5407 (95% CI, 2663-8152).ConclusionEvidence from the BOXIT trial suggests that patients with NMIBC will both experience decrements in HRQoL and incur significant costs, especially in the event of a grade 3 recurrence or a progression to MIBC.
Highlights
Bladder cancer is the 9th most common cancer and ranks 13th in terms of cancer-associated mortality worldwide.[1]
The present study has provided new evidence on the costs and health-related quality of life (HRQoL) associated with non emuscle-invasive bladder cancer (NMIBC) occurrence, recurrence, and progression to muscle-invasive bladder cancer (MIBC), supporting future clinical and economic evaluations
The results from our analysis of the BOXIT trial data suggest that patients with NMIBC will experience decrements in HRQoL, with significant costs imposed in the event of disease recurrence or progression, and the costs increasing with the abnormality and invasiveness of the lesion
Summary
Bladder cancer is the 9th most common cancer and ranks 13th in terms of cancer-associated mortality worldwide.[1] In the United Kingdom, bladder cancer accounts for 3% of all new cancer cases, Submitted: Oct 6, 2019; Revised: Dec 1, 2019; Accepted: Dec 9, 2019; Epub: Dec 14, 2019. - e418 Clinical Genitourinary Cancer August 2020. This distinction is important because the involvement of cancer invading the muscle carries a significantly worse prognosis and requires radical cystectomy, radical chemotherapy, or radical radiotherapy, with or without neoadjuvant chemotherapy. NMIBC has had more favorable survival rates but recurs frequently and has been associated with repeated outpatient visits, cytologic and cystoscopic monitoring, and adjuvant intravesical treatment regimens after transurethral resection
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