Cost-effectiveness of surveillance schedules in older adults with non-muscle-invasive bladder cancer

To estimate the cost-effectiveness of surveillance schedules for Non-muscle-invasive bladder cancer (NMIBC) among older adults.

We developed a MISCAN microsimulation model to compare the cost-effectiveness of various surveillance schedules (quarterly to biennally, for 2, 5 or 10 years or lifetime) for older adults with NMIBC (age 65 to 85 years). For each surveillance schedule we calculated total costs per patient and the number of quality adjusted life-years (QALYs) gained. Incremental cost-effectiveness ratios (ICERs) as incremental costs per QALY gained were calculated, using 3% discount.

As age increased, the number of QALYs gained per patient decreased substantially. Surveillance of patients age 65 resulted in 2-7 QALYs gained, whereas surveillance at age 85 led to less than 1 QALYs gained. Total costs of the surveillance schedules also decreased as age increased. The ICER of biannually surveillance at age 65 for lifetime was $4,999/QALY gained. Among patients over 75, the incremental yield of QALY gains for any increase in surveillance frequency and/or length was quite modest (less than 2 QALYs gained).

With increasing age, surveillance for recurrences leads to substantially fewer QALYs gained. These data support age-specific surveillance recommendations for patients treated for non-muscle-invasive bladder cancer. This article is protected by copyright. All rights reserved.

BJU international. 2018 Aug 01 [Epub ahead of print]

E A M Heijnsdijk, D Nieboer, T Garg, I Lansdorp-Vogelaar, H J de Koning, M E Nielsen

Department of Public Health, Erasmus MC, Rotterdam, the Netherlands., Departments of Urology, Epidemiology & Health Services Research Geisinger, Danville, PA, US., Departments of Urology, Epidemiology and Health Policy & Management, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, US.