Mp57-10 Benefits and Costs of Alternative Guidelines for Surveillance of Low-Grade (Lg) Non-Muscle Invasive Bladder Cancer (Nmibc)

You have accessJournal of UrologyHealth Services Research: Value of Care: Cost and Outcomes II (MP57)1 May 2024MP57-10 BENEFITS AND COSTS OF ALTERNATIVE GUIDELINES FOR SURVEILLANCE OF LOW-GRADE (LG) NON-MUSCLE INVASIVE BLADDER CANCER (NMIBC) Zhuo T. Su, Katherine Mahon, Michael Rezaee, Sunil Patel, Jeffrey Townsend, and Max Kates Zhuo T. SuZhuo T. Su , Katherine MahonKatherine Mahon , Michael RezaeeMichael Rezaee , Sunil PatelSunil Patel , Jeffrey TownsendJeffrey Townsend , and Max KatesMax Kates View All Author Informationhttps://doi.org/10.1097/01.JU.0001009420.83948.eb.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: How to reduce the high costs of bladder cancer care without compromising clinical outcomes remains understudied. We used simulations to compare the benefits and costs of major guidelines for surveillance of LG NMIBC. METHODS: We developed a Monte-Carlo simulation to model the 10-year outcomes and costs of 5 guidelines for surveillance of a cohort of 10,000 patients diagnosed with LGTa or LGT1 NMIBC at age 70 years: the American Urological Association (AUA), National Comprehensive Cancer Network (NCCN), European Association of Urology (EAU), Canadian Urological Association (CUA), and National Institute for Health and Care Excellence (NICE). We assessed separately the most intense (denoted as AUAi and CUAi) and relaxed (AUAr and CUAr) surveillance regimens within the range of surveillance frequencies allowed by the AUA and CUA guidelines. RESULTS: For LGTa, 10-year cumulative incidence (CI) of muscle invasive bladder cancer (MIBC) ranged from 0.3% (CUAi) to 0.6% (NICE); cancer-specific survival (CSS) and overall survival (OS) were both nearly identical across guidelines (Table 1). For LGT1, AUAi and CUAi both led to the best MIBC CI (4.1%), CSS (71.8%), and OS (98.2%), while AUAr had the worst MIBC CI (5.5%; absolute difference 1.4%), CSS (71.4%; 0.4%), and OS (97.4%; 0.8%). In cost-effectiveness analysis, NICE was the optimal option for LGTa as it obtained similar health utilities versus the other surveillance regimens but incurred the lowest costs (Table 2). For LGT1, more stringent regimens such as CUAi achieved higher health utilities but also had high incremental costs compared to less stringent regimens and were not cost-effective per conventional cost-effectiveness thresholds. CONCLUSIONS: For LGTa, relatively less stringent surveillance regimens led to cost savings without markedly affecting oncological outcomes and were cost-effective. For LGT1, more stringent surveillance regimens achieved better oncological outcomes but incurred much higher costs to be deemed cost-effective versus less stringent regimens. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e941 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Zhuo T. Su More articles by this author Katherine Mahon More articles by this author Michael Rezaee More articles by this author Sunil Patel More articles by this author Jeffrey Townsend More articles by this author Max Kates More articles by this author Expand All Advertisement PDF downloadLoading ...