MP73-07 INTRAVESICAL CHEMOTHERAPY FOR LOW GRADE BLADDER CANCER: A COST ANALYSIS

Abstract

You have accessJournal of UrologyBladder Cancer: Non-invasive IV (MP73)1 Apr 2020MP73-07 INTRAVESICAL CHEMOTHERAPY FOR LOW GRADE BLADDER CANCER: A COST ANALYSIS Niranjan Sathianathen, Jacob Gantz*, Fernando Alarid-Escudero, Karen Kuntz, Nathan Lawrentschuk, Badrinath Konety, and Edward Messing Niranjan SathianathenNiranjan Sathianathen More articles by this author , Jacob Gantz*Jacob Gantz* More articles by this author , Fernando Alarid-EscuderoFernando Alarid-Escudero More articles by this author , Karen KuntzKaren Kuntz More articles by this author , Nathan LawrentschukNathan Lawrentschuk More articles by this author , Badrinath KonetyBadrinath Konety More articles by this author , and Edward MessingEdward Messing More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000959.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intravesical chemotherapy has been demonstrated to delay recurrence in low-risk non-muscle invasive bladder cancer (LR NMIBC). Mitomycin C has been the most commonly utilized agent in this setting but recently the SWOG S0337 randomized trial reported that gemcitabine reduced recurrences. We therefore assessed the cost-effectiveness of these agents in LR NMIBC. METHODS: A state transition model was developed to simulate the management of men diagnosed with LR NMIBC. At the time of initial diagnosis, men were hypothetically treated with intravesical gemcitabine, intravesical mitomycin or no intravesical therapy. We then modelled the natural history of disease for a time horizon of five years and superimposed guideline-based surveillance and treatment strategies. Recurrence and progression rates were informed from the literature and primary data from the SWOG S0337 trial. Costs were calculated from the health sector perspective using 2018 US dollars and effectiveness was measured in quality-adjusted life years (QALYs). RESULTS: Compared to no intravesical therapy at the time of initial transurethral resection for low-risk NMIBC, Gemcitabine treatment improved quality-adjusted survival by 2.16 months and reduced costs by $2,694.30 (Table 1). Mitomycin C also improved survival by 0.84 months and decreased costs by $517 relative to no intravesical treatment but was not cost-effective compared to Gemcitabine. On sensitivity analysis, the hazard ratio of Gemcitabine for recurrent disease had to be less than 0.87 for it to remain the superior treatment strategy compared to no treatment. If the hazard ratio for Mitomycin C is less then 0.65 then it becomes the preferred strategy. CONCLUSIONS: The utilization of intravesical chemotherapy is cost-effective in LR NMIBC by decreasing recurrences and subsequent treatment. Intravesical gemcitabine reduced costs and improved quality-adjusted survival compared to intravesical mitomycin C or no intravesical chemotherapy. Source of Funding: Urology Care Foundation Resident Research Award; Kahlert Foundation © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1123-e1124 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Niranjan Sathianathen More articles by this author Jacob Gantz* More articles by this author Fernando Alarid-Escudero More articles by this author Karen Kuntz More articles by this author Nathan Lawrentschuk More articles by this author Badrinath Konety More articles by this author Edward Messing More articles by this author Expand All Advertisement PDF downloadLoading ...