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Kulkarni GS et al. - In a trial to assess the use of immediate radical cystectomy vs intravesical Bacillus Calmette-Guerin (BCG) therapy for high-risk, high-grade (T1G3) bladder cancer, it was shown that compared with BCG therapy, immediate radical cystectomy for average pts with high-risk, T1G3 bladder cancer yielded better health outcomes and lower costs. Tailoring therapy based on pt age and comorbidity may increase survival while yielding significant cost-savings for the health care system.
Methods- A Markov Monte-Carlo cost-effectiveness model was created to simulate the outcomes of a cohort of pts with incident, high-risk, T1G3 bladder cancer.
- Treatment options included immediate cystectomy and conservative therapy with intravesical BCG.
- The base case was a man aged 60 yrs.
- Parameter uncertainty was assessed with probabilistic sensitivity analyses.
- Scenario analyses were used to explore 2 strategies among pts stratified by age and comorbidity.
- The quality-adjusted survival with immediate cystectomy and BCG therapy was 9.46 quality-adjusted life-yrs (QALYs) and 9.39 QALYs, respectively.
- Corresponding mean per-pt discounted lifetime costs (in 2005 Canadian dollars) were $37,600 and $42,400, respectively.
- At a willingness-to-pay threshold of $50,000 per QALY, the probability that immediate cystectomy was cost-effective was 67%.
- Immediate cystectomy was the dominant (more effective and less expensive) therapy for pts aged <60 yrs, whereas BCG therapy was dominant for pts aged >75 yrs.
- With increasing comorbidity, BCG therapy was dominant at lower age thresholds.
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