Limited evidence exists regarding the cost and health-related quality of life (HRQoL) effects of non-muscle-invasive bladder cancer (NMIBC) recurrence and progression to muscle-invasive bladder cancer (MIBC). We examined these effects using evidence from a recent randomized control trial.
The costs and HRQoL associated with bladder cancer were assessed using data from the BOXIT trial (bladder COX-2 inhibition trial; n = 472). The cost and HRQoL effects from clinical events were estimated using generalized estimating equations. The costs were derived from the recorded resource usage and UK unit costs. HRQoL was assessed using the EQ-5D-3L and reported UK preference tariffs. The events were categorized using the TMN classification.
Cases of grade 3 recurrence and progression were associated with statistically significant HRQoL decrements (-0.08; 95% confidence interval [CI], -0.13 to -0.03; and -0.10; 95% CI, -0.17 to -0.03, respectively). The 3-year average cost per NMIBC patient was estimated at £8735 (95% CI, 8325-9145). Cases of grade 1, 2, and 3 recurrence were associated with annual cost effects of £1218 (95% CI, 403-2033), £1677 (95% CI, 920-2433), and £3957 (95% CI, 2332-5583), respectively. Progression to MIBC was associated with an average increase in costs of £5407 (95% CI, 2663-8152).
Evidence from the BOXIT trial suggests that patients with NMIBC will both experience decrements in HRQoL and incur significant costs, especially in the event of a grade 3 recurrence or a progression to MIBC.
Clinical genitourinary cancer. 2019 Dec 14 [Epub ahead of print]
Edward Cox, Pedro Saramago, John Kelly, Nuria Porta, Emma Hall, Wei Shen Tan, Mark Sculpher, Marta Soares
Centre for Health Economics, University of York, York, United Kingdom. Electronic address: ., Centre for Health Economics, University of York, York, United Kingdom., Division of Surgery and Interventional Science, University College London, London, United Kingdom; Department of Urology, University College London Hospital, London, United Kingdom., Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom., Division of Surgery and Interventional Science, University College London, London, United Kingdom; Department of Urology, Imperial College Healthcare, London, United Kingdom.