In the setting of increased health care expenditures, we have to further analyze each novel technology from a standpoint of cost effectiveness. To that effect, the authors completed contemporary cost-effectiveness assessment of BLC compared to WLC at the time of TURBT. They generated a decision and cost-effectiveness model with a five-year time horizon following initial TURBT; the model was created from the healthcare payer perspective. They used a meta-analysis of contemporary recurrence and progression rates. Recurrence relative risk (RR) was 076 for BLC+HAL vs. WLC. A decision model adapted from the UK’s National Healthcare System (NHS). Cost variables included in the model were from three large Canadian bladder cancer centers. Primary outcomes were number of recurrences prevented, bed days saved, and overall costs.
Their key findings:
- Variable cost from province to province. The five-year cost of using BLC with HAL on all incident NMIBC compared to WLC assistance was $4,832,908 for Ontario (n=4696; $1372/patient); $1,168,968 for British Columbia (n=1204; $1295/patient); and $2,484,872 (n=2680; $1236/patient) for Quebec
- Use of BLC with HAL would result in 87,338 fewer recurrences annually. On sensitivity/scenario analyses for Ontario data, if BLC with HAL equipment were provided to the province at no cost, five-year costs would be $4,158 814 and $1181 cost per patient
- If BLC with HAL were only used for cystoscopically appearing aggressive tumors, the five-year amortized cost in Ontario would be $3,874,098, with a cost per patient of $1222
- If there was a 20% or 50% improvement in progression rates with BLC plus HAL, the five-year amortized cost would be $2,660,529 and -$598,039 (cost-saving), respectively.
Limitations / Discussion Points:
- Limited to Canadian cancer centers – a nationalized health care system. The costs are not generalizable to other health care systems.
- The data does not necessarily account for reduced cost of interventions such as cystectomy, chemotherapy, or radiation for patients that would no longer progress to muscle invasive therapy.
Co-Authors: Kathy Li MPH, Wassim Kassouf MD, Peter C. Black MD, Alice Dragomir MSc, PhD and Girish S. Kulkarni MD, PhD, University of Toronto
Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, Twitter: @tchandra_uromd at the 18th Annual Meeting of the Society of Urologic Oncology, November 20-December 1, 2017 – Washington, DC