PD55-02 MOLECULAR SUBTYPING TO STRATIFY THE TREATMENT OF MUSCLE-INVASIVE BLADDER CANCER: A COST EFFECTIVENESS ANALYSIS

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive IV (PD55)1 Sep 2021PD55-02 MOLECULAR SUBTYPING TO STRATIFY THE TREATMENT OF MUSCLE-INVASIVE BLADDER CANCER: A COST EFFECTIVENESS ANALYSIS Diana Magee, Douglas Cheung, Beate Sander, and Girish Kulkarni Diana MageeDiana Magee More articles by this author , Douglas CheungDouglas Cheung More articles by this author , Beate SanderBeate Sander More articles by this author , and Girish KulkarniGirish Kulkarni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002089.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The gold standard treatment for muscle invasive bladder cancer (MIBC) is neoadjuvant chemotherapy (NAC) followed by radical cystectomy. However, response to NAC is unpredictable. Molecular subtypes allow for an improved ability to select a tailored treatment course. Our study aimed to assess the cost-effectiveness of molecular subtyping in the management of MIBC. METHODS: A two-dimensional Markov microsimulation model was developed using TreeAge Pro comparing three strategies: NAC at current usage rates (36%), universal NAC usage, and molecular subtype-directed care. Model probabilities and utilities were derived from the published literature. Four distinct subtypes of MIBC were modelled based on the Seiler classification. Cost of each phase of care was obtained from primary data and the Canadian Institute for Health Information patient cost estimator. The primary outcomes were quality-adjusted life years (QALYs), cost (CAD), overall survival (OS) and the incremental cost-effectiveness ratio (ICER). RESULTS: The predicted QALYs were 8.34, 8.73, and 9.14 with costs of $62,478, $76,962, and $62,579 for NAC at current usage rates, universal NAC usage, and subtype-directed care, respectively. Probabilistic sensitivity analysis shown in Figure 1. OS at 10 years was 39.2%, 40.8% and 42.8% for NAC at current usage rates, universal NAC usage, and subtype-directed care, respectively. When comparing subtype-directed care to current rates of NAC usage the ICER was $127/QALY. Subtype-directed care dominated universal NAC usage. CONCLUSIONS: We demonstrated that in patients with MIBC a molecular subtype directed approach to the administration of NAC results in improved OS and greater QALYs; moreover, it is cost-effective within a single payer healthcare system. A push for the universal use of NAC will result in improved survival compared with what our current rates of use achieve but it is likely not the best approach considering the drawbacks of chemotherapy including toxicity and unequal response. This model is built upon the available literature and as such requires validation prior to clinical implementation. Source of Funding: This project was funded by a grant from the Canadian Urologic Oncology Group © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e997-e997 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Diana Magee More articles by this author Douglas Cheung More articles by this author Beate Sander More articles by this author Girish Kulkarni More articles by this author Expand All Advertisement Loading ...