PD55-03 COST-EFFECTIVENESS OF RADICAL CYSTECTOMY VS. TRIMODALITY THERAPY FOR MUSCLE INVASIVE BLADDER CANCER

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive V (PD55)1 Apr 2020PD55-03 COST-EFFECTIVENESS OF RADICAL CYSTECTOMY VS. TRIMODALITY THERAPY FOR MUSCLE INVASIVE BLADDER CANCER Nathan Suskovic*, Ann Raldow, Trevor Royce, and Angela Smith Nathan Suskovic*Nathan Suskovic* More articles by this author , Ann RaldowAnn Raldow More articles by this author , Trevor RoyceTrevor Royce More articles by this author , and Angela SmithAngela Smith More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000965.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Muscle invasive bladder cancer (MIBC) comprises 25% of all bladder cancers at the time of diagnosis. Radical Cystectomy (RC) has traditionally been the gold standard curative treatment for MIBC. Trimodality therapy (TMT) with maximal transurethral resection of bladder tumor, chemotherapy, and radiation is a treatment alternative and Category 1 recommendation by the NCCN. TMT has shown equivalent survival for carefully selected patients. However, the comparative cost effectiveness between RC and TMT is unknown. Therefore, the purpose of this study was to compare the cost-effectiveness of RC versus TMT for MIBC. METHODS: We developed a Markov model using TreeAge software to simulate a 5-year outcome for one million 65-year old hypothetical patients with MIBC undergoing either RC or TMT (Figure 1). Hypothetical patients in the RC treatment pathway would have an adverse event, no adverse event, or immediate death after surgery. After RC, patients either would have no evidence of disease or transition to locoregional recurrence, metastatic recurrence, or death. Hypothetical patients in the TMT treatment pathway would either have an adverse event or no adverse from treatment. After TMT, patients either would have disease-free bladder intact survival or transition to locoregional failure, metastatic recurrence, or death. Patients with locoregional failure from TMT transition into non-salvageable disease or salvageable disease. Patients with salvageable disease prompted a salvage cystectomy. Model probabilities and utilities were extracted from the literature. Costs were derived from 2019 National Medicare Fee Schedule. RESULTS: RC and TMT were associated with quality adjusted life years (QALY) of 2.88 and 3.38 respectively (incremental QALYs of 0.5 favoring TMT). The mean costs of RC and TMT were $37,107 and $23,916 respectively. TMT was less expensive with an incremental cost of $13,191. CONCLUSIONS: In patients aged 65 and older with MIBC, TMT was the dominant strategy as compared to RC, as it was both cheaper and associated with increased QALYs based upon model assumptions. The results of this study are the first to evaluate the cost effectiveness of RC and TMT and can inform the ongoing discussion regarding the use of TMT and RC in MIBC. Source of Funding: Office of Research at the University of North Carolina at Chapel Hill © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1182-e1183 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nathan Suskovic* More articles by this author Ann Raldow More articles by this author Trevor Royce More articles by this author Angela Smith More articles by this author Expand All Advertisement PDF downloadLoading ...