427 EVALUATING COST AND QUALITY OF LIFE IN NON-MUSCLE INVASIVE BLADDER CANCER

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost effectiveness (III)1 Apr 2013427 EVALUATING COST AND QUALITY OF LIFE IN NON-MUSCLE INVASIVE BLADDER CANCER Jacob Bobman, Christopher Deibert, Jennifer Ahn, Scott Stevenson, Mitchell Benson, and James McKiernan Jacob BobmanJacob Bobman New York, NY More articles by this author , Christopher DeibertChristopher Deibert New York, NY More articles by this author , Jennifer AhnJennifer Ahn New York, NY More articles by this author , Scott StevensonScott Stevenson New York, NY More articles by this author , Mitchell BensonMitchell Benson New York, NY More articles by this author , and James McKiernanJames McKiernan New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1817AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder cancer is the most expensive cancer to treat on a per-patient and per-death basis in the Medicare system, with an estimated financial burden of $3.98 billion/year. The majority of patients initially present with non-muscle invasive bladder cancer (NMIBC), requiring primary treatment and strict surveillance protocols. Previous studies have explored cost-effective strategies that maximize survival, but not quality of life (QOL). Our aim was to evaluate the cost of NMIBC in the context of quality of life. METHODS We reviewed our IRB-approved Columbia University Urologic Oncology Database for patients with an initial diagnosis of NMIBC from 2004-2012. One hundred patients were randomly selected, and the costs of all diagnostics, intravesical therapy (IVT), surgeries, complications, and imaging were tallied utilizing internal billing and national Medicare estimates. QOL was assessed using utility estimates (patient-rated QOL for each possible health state), and the number of quality-adjusted life years (QALYs) was calculated by multiplying the utilities by the total time spent in that utility state and summing these values. Dividing the total average cost by the total average number of QALYs gained per patient gives the cost required to add one QALY. Patients were stratified into four treatment groups: 1) IVT + cystectomy (RC); 2) IVT + maintenance + RC; 3) IVT + maintenance; and 4) immediate RC. RESULTS The patient cohort was 73% male, median age at diagnosis was 67 years (38-90) and median follow-up was 44 months (1.5-103.5). Figure 1 demonstrates that IVT + maintenance adds the most QALYs and is the most cost-effective for overall survival and quality of life, requiring $8862 to add one QALY to one patient's life. The other three treatment strategies were approximately equal, with IVT + maintenance + delayed RC being the least cost-effective, at $21158/QALY. CONCLUSIONS Treating NMIBC with IVT + maintenance adds the most QALYs compared with treatments involving cystectomy. Therefore, delaying cystectomy with additional maintenance therapy may be the most cost-effective option (if medically advisable), since it has the potential to add QALY at low cost, and late RC costs no more than early RC to add the same QALY. Cost Follow-up (yrs) Cost/Yrs Survival QALY Cost/QALY IVT + RC (n = 31) $53503.57 3.53 $15156.82 3.248 $16474.80/QALY IVT + maint + RC (n = 25) $78150.90 3.88 $20141.98 3.694 $21157.55/QALY IVT + maint (n = 14) $45601.44 5.24 $8702.56 5.146 $8862.08/QALY Immediate RC (n = 30) $52369.53 3.19 $16416.78 2.858 $18322.30/QALY © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e174 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Metrics Author Information Jacob Bobman New York, NY More articles by this author Christopher Deibert New York, NY More articles by this author Jennifer Ahn New York, NY More articles by this author Scott Stevenson New York, NY More articles by this author Mitchell Benson New York, NY More articles by this author James McKiernan New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...