Mp53-04 Neoadjuvant Versus Adjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: A Decision Analysis

You have accessJournal of UrologyBladder Cancer: Invasive V (MP53) 1 May 2024MP53-04 NEOADJUVANT VERSUS ADJUVANT CHEMOTHERAPY FOR MUSCLE-INVASIVE BLADDER CANCER: A DECISION ANALYSIS Luca Afferi, Beate Jahn, Christian D. Fankhauser, Richard Cathomas, Joaquim Bellmunt, Marco Moschini, Agostino Mattei, Steven L. Chang, and Uwe Siebert Luca AfferiLuca Afferi, Beate JahnBeate Jahn, Christian D. FankhauserChristian D. Fankhauser, Richard CathomasRichard Cathomas, Joaquim BellmuntJoaquim Bellmunt, Marco MoschiniMarco Moschini, Agostino MatteiAgostino Mattei, Steven L. ChangSteven L. Chang, and Uwe SiebertUwe Siebert View All Author Informationhttps: //doi. org/10. 1097/01. JU. 0001008784. 37684. bd. 04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Evidence on the cost-effectiveness of neoadjuvant (NAC) versus adjuvant (ACT) cisplatin-based chemotherapy for muscle invasive bladder cancer (MIBC) is missing. We aimed to evaluate the long-term quality-adjusted life years (QALYs) and cost-effectiveness of different strategies for treating patients (pts) with MIBC through a decision analysis approach. METHODS: An individual-level state transition microsimulation model for pts with urothelial non-metastatic MIBC eligible for surgery and NAC was developed. Over a lifelong-time horizon, four strategies simulating 100, 000 pts were evaluated: (i) no treatment, (ii) radical cystectomy (RC) without perioperative chemotherapy, (iii) NAC followed by RC (reference strategy) and (iv) RC followed by ACT (administered according to surgical pathology). Endpoints were QALYs and costs. Utilities were obtained from recent cost-effectiveness analysis. Survival data were obtained from selected randomized controlled trials and, if not available, retrospective cohort analysis. Costs were estimated from the United States healthcare perspective; past costs were corrected for inflation. A 3% discount rate for health effects and costs was applied. A sensitivity analysis on the probability of being fit for ACT after surgery was performed to account for uncertainty of this estimate. The model was face-validated independently by two urologists. RESULTS: Discounted life-expectancy was 4. 63 QALYs for ACT, 4. 46 QALYs for NAC, 4. 37 QALYs for RC without perioperative chemotherapy and 2. 85 QALYs for pts receiving no treatment. Costs were lowest for ACT (US45, 861) compared to NAC (US48, 434), RC without perioperative chemotherapy (US49, 732) and no treatment (US59, 994). Sensitivity analysis showed that NAC would lead to improved QALYs than ACT if the estimated probability (at diagnosis) of being fit for ACT after surgery would be less than 32%. CONCLUSIONS: Perioperative chemotherapy is associated with improved QALYs and is cost saving compared to RC alone. ACT leads to slightly increased QALYs and is cost effective compared to NAC. QALYs for NAC and ACT are similar if the initial estimated risk of being unfit for chemotherapy after surgery is high. Choosing NAC versus ACT should be ultimately based on the available evidence as well as pts' factors and expectations. Download PPT Source of Funding: SAKK/Dr. Paul Janssen Fellowship; Dr. Arnold U. und Susanne Huggenberger-Bischoff Stiftung; Luzerner Kantonsspital © 2024 by American Urological Association Education and Research, Inc. FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e863 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc. Metrics Author Information Luca Afferi More articles by this author Beate Jahn More articles by this author Christian D. Fankhauser More articles by this author Richard Cathomas More articles by this author Joaquim Bellmunt More articles by this author Marco Moschini More articles by this author Agostino Mattei More articles by this author Steven L. Chang More articles by this author Uwe Siebert More articles by this author Expand All Advertisement PDF downloadLoading. . .