Presentation Authors: Matthew Mossanen, Ye Wang, Julie A. Szymaniak*, Boston, MA, Wei Shen Tan, London, United Kingdom, Melissa J. Huynh, Mark A. Preston, Quoc-Dien Trinh, Guru Sonpavde, Deborah Schrag, Adam S. Kibel, Steven L. Chang, Boston, MA
Introduction: Non-muscle invasive bladder cancer (NMIBC) is a biologically heterogeneous disease and is one of the most expensive malignancies to treat on a per patient basis. In part, this high cost is attributed to the need for long-term surveillance. Prognostic factors for disease recurrence and progression can classify patients into low, intermediate, and high-risk categories to guide management strategies. We sought to perform an economic analysis of surveillance strategies to elucidate sources of costs in the management of NMIBC.
Methods: A Markov model was constructed to determine the average 5-year costs for the surveillance of patients with NMIBC. Patients were stratified into low, intermediate, and high-risk groups based on the EORTC risk calculator to determine recurrence and progression rates according to each category. The index patient was a compliant 65-year-old male. A total of four health states were utilized in the Markov model: no evidence of disease, recurrence, progression and cystectomy, and death. Low-risk patients underwent cystoscopy 3 months after TURBT, at 9 months, then annually until 5 years. Intermediate/high-risk patients underwent cystoscopy 3 months after TURBT, then every 3 months for 2 years, followed by every 6 months until 5 years.
Results: Cumulative costs of care over a 5-year period were approximately $52,125 for low-risk, $146,250 for intermediate-risk, and $366,143 for high-risk NMIBC. The primary driver of cost was progression to muscle-invasive disease requiring definitive therapy, contributing to 81% and 92% of overall cost for intermediate and high-risk disease. Although low-risk tumors have a high likelihood of 5-year recurrence, the overall cost contribution of recurrence was 8%, whereas disease progression accounted for 71%.
Conclusions: Although protracted surveillance cystoscopy contributes to the expenditures associated with NMIBC, progression substantially increases the overall cost of care across all three patient risk groups and most notably for intermediate and high-risk disease patients.