Cost-Effectiveness of Trimodal Therapy and Radical Cystectomy for Muscle-Invasive Bladder Cancer

Area of Science:

• Urology
• Health Economics
• Oncology

Background:

• Trimodal therapy (TMT) is an alternative to radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC).
• Recent analyses show similar oncologic outcomes between TMT and RC for eligible patients.
• Comparative value data are limited.

Purpose of the Study:

• To evaluate the comparative cost-effectiveness of TMT versus RC for MIBC treatment.
• To assess long-term outcomes and costs from a Medicare perspective.

Main Methods:

• Health transition state microsimulation model comparing TMT and RC for MIBC.
• Model probabilities informed by 2023 retrospective analyses of patients treated 2005-2017.
• Analysis included 5- and 10-year horizons for a typical 71-year-old patient with cT2-4aN0M0 MIBC.

Main Results:

• TMT incurred higher average costs ($30,525 more at 5 years) than RC.
• TMT yielded slightly higher quality-adjusted life years (QALYs) (3.94 vs. 3.87).
• TMT was not cost-effective at 5 or 10 years (ICERs >$300,000/QALY).

Conclusions:

• TMT improves quality of life but is not cost-effective compared to RC for MIBC at 5 and 10 years due to higher costs.
• Cost-effectiveness could be achieved if TMT costs decrease or metastasis-free survival improves significantly.
• Policy initiatives to reduce TMT costs and patient counseling on long-term effects are recommended.