Trimodal therapy vs. radical cystectomy for muscle-invasive bladder cancer: A Canadian cost-effectiveness analysis.

Trimodal therapy (TMT) is a suitable alternative to neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) for patients with muscle-invasive bladder cancer (MIBC). In this study, we conducted a cost-effectiveness evaluation of RC±NAC vs. TMT for MIBC in the universal and publicly funded Canadian healthcare system.

We developed a Markov model with Monte-Carlo microsimulations. Rates and probabilities of transitioning within different health states (e.g., cure, locoregional recurrence, distant metastasis, death) were input in the model after a scoped literature review. Two main scenarios were considered: 1) academic center; and 2) populational-level. Results were reported in life-years gained (LYG), quality-adjusted life years (QALY), and incremental cost- effectiveness ratios (ICER). A sensitivity analysis was performed.

A total of 20 000 patients were simulated. For the academic center model, TMT was associated with increased effectiveness (both in LYG and QALY) at a higher cost compared to RC±NAC, at five and 10 years. This resulted in an ICER of $19 746/QALY per patient undergoing the TMT strategy at 10 years of followup. For the populational-level model, RC±NAC was associated with higher effectiveness at 10 years, with an ICER of $3319/QALY per patient. This study was limited by heterogeneity within the studies used to build the model.

In this study, TMT performed in academic centers was cost-effective compared to RC±NAC, with higher effectiveness at a higher cost. On the other hand, RC±NAC was considered cost-effective compared to TMT at the populational-level. Further studies are needed to confirm these results.

Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 2022 Jan 27 [Epub ahead of print]

Ronald Kool, Ivan Yanev, Tarek Hijal, Marie Vanhuyse, Fabio L Cury, Luis Souhami, Wassim Kassouf, Alice Dragomir

Division of Urology, McGill University Health Centre, McGill University, Montreal, QC, Canada., Division of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada., Division of Medical Oncology, McGill University Health Centre, McGill University, Montreal, QC, Canada.