Cost-effectiveness analysis of different treatment modalities in BCG-unresponsive NMIBC

Title data

Rieger, Constanin ; Schlüchtermann, Jörg ; Storz, Enno ; Kastner, Lucas ; Pfister, David ; Heidenreich, Axel:
Cost-effectiveness analysis of different treatment modalities in BCG-unresponsive NMIBC.
In: BJU International. Vol. 134 (2024) Issue 4 . - pp. 528-588.
ISSN 1464-410X
DOI: https://doi.org/10.1111/bju.16332

Official URL:

Abstract in another language

Objective: Radical cystectomy (RC) is the standard of care (SOC) in BCG-unresponsive NMIBC and is associated with a significant health-related quality-of-life burden. Recently, promising results have been published on Gemcitabine/Docetaxel, Pembrolizumab, and Hyperthermic Intravesical Chemotherapy (HIVEC) as salvage therapy options trying to increase the rate of bladder preservation. Here, we performed a Cost-Effectiveness-Analysis of those treatment modalities.

Patients and methods: We developed a Markov model from a payer's perspective drawing on clinical data of single-arm trials testing intravesical gemcitabine/docetaxel and pembrolizumab in BCG-unresponsive NMIBC, as well as clinical data from patients receiving hyperthermic intravesical chemotherapy HIVEC (n = 29) as intravesical salvage chemotherapy at our uro-oncological centre in Cologne. Costs were simulated utilising a non-commercial diagnosis-related groups grouper, utilities were derived from comparable cost-effectiveness studies. We used a Monte Carlo simulation to identify the optimal treatment, comparing the incremental cost effectiveness ratios (ICERs) at a willingness-to-pay threshold of €50 000 (euro)/quality-adjusted life year (QALY).

Results: Over a horizon of 10 years, gemcitabine/docetaxel, HIVEC, and pembrolizumab were associated with costs of €48 353, €64 438, and €204 580, as well as a gain of QALYs of 6.16, 6.48, and 6.00, resulting in an ICER of €26 482, €42 567, and €184 533 respectively, in comparison to RC with total costs of €21 871 and a gain of QALYs of 5.01. Monte Carlo simulation identified HIVEC as the treatment of choice under assumption of a WTP of <€50 000.

Conclusion: Considering a WTP of <€50 000/QALY, gemcitabine/docetaxel and HIVEC are highly cost-effective therapeutic options in BCG-refractory NMIBC, while RC remains the cheapest option. At its current price, pembrolizumab would only be cost-effective assuming a price reduction of at least 70%.

Further data

Item Type:	Article in a journal
Refereed:	Yes
Keywords:	BCG unresponsive; HIVEC; bladder cancer; cost‐effectiveness; pembrolizumab
Institutions of the University:	Faculties > Faculty of Law, Business and Economics > Department of Business Administration > Chair Business Administration V - Production Management and Industrial Economics > Chair Business Administration V - Production Management and Industrial Economics - Univ.-Prof. Dr. Jörg Schlüchtermann
Result of work at the UBT:	Yes
DDC Subjects:	300 Social sciences > 330 Economics 600 Technology, medicine, applied sciences > 610 Medicine and health
Date Deposited:	16 Jan 2025 07:03
Last Modified:	16 Jan 2025 07:03
URI:	https://eref.uni-bayreuth.de/id/eprint/91606