The Urology Centre, Guys and St. Thomas' NHS Foundation Trust.
BJU Int. 2013 Sep;112(5):561-7. doi: 10.1111/bju.12216. Epub 2013 Jul 2.
To evaluate the safety, tolerability and effectiveness of outpatient (office-based) laser ablation (OLA), with local anaesthetic, for non-muscle-invasive bladder cancer (NMIBC) in an elderly population with and without photodynamic diagnosis (PDD). To compare the cost-effectiveness of OLA of NMIBC with that of inpatient cystodiathermy (IC).
We conducted a prospective cohort study of patients with NMIBC treated with OLA by one consultant surgeon between March 2008 and July 2011 A subgroup of patients had PDD before undergoing OLA. Safety and effectiveness were determined by complications (In the immediate post operative period, at three days and at three months), patient tolerability (visual analogue score) and recurrence rates. The long-term costs and cost-effectiveness of OLA and IC of NMIBC were evaluated using Markov modeling.
A total of 74 OLA procedures (44 white-light, 30 PDD) were carried out in 54 patients. The mean (range) patient age was 77 (52-95) years. More than half of the patients had more than three comorbidities. Previous tumour histology ranged from G1pTa to T3. One patient had haematuria for 1 week which settled spontaneously and did not require hospital admission. There were no other complications. The procedure was well tolerated with pain scores of 0-2/10. Additional lesions were found in 21% of patients using PDD that were not found using white light. At 3 months, the percentage of patients who had recurrence after OLA with white light and OLA with PDD were 10.6 and 4.3%, respectively. At 1 year, 65.1% and 46.9% of patients had recurrence. The cost of OLA was found to be much lower than that of IC (£538 vs £1474), even with the addition of PDD (£912 vs £1844). Over the course of a patient's lifetime, OLA was more clinically effective, measured in quality-adjusted life-years (QALY), than IC (0.147 [sd 0.059]) and less costly (£2576.42 [sd £7293.07]). At a cost-effectiveness threshold of £30,000/QALY, as set by the National Institute for Health and Care Excellence, there was an 82% probability that OLA was cost-effective.
This is the first study to demonstrate the long-term cost-effectiveness of OLA of NMIBC. The results support the use of OLA for the treatment of NMIBC, especially in the elderly.
评估门诊（基于办公室的）激光消融术（OLA）在有和没有光动力诊断（PDD）的老年非肌肉浸润性膀胱癌（NMIBC）患者中的安全性、耐受性和有效性。比较 NMIBC 患者行 OLA 与住院膀胱冲洗（IC）的成本效益。
我们进行了一项前瞻性队列研究，纳入了 2008 年 3 月至 2011 年 7 月期间由一位顾问外科医生对 NMIBC 患者进行 OLA 治疗的患者。亚组患者在进行 OLA 前进行了 PDD。通过并发症（术后即刻、术后 3 天和术后 3 个月）、患者耐受性（视觉模拟评分）和复发率来确定安全性和有效性。使用马尔可夫模型评估 NMIBC 的 OLA 和 IC 的长期成本和成本效益。
54 名患者共进行了 74 次 OLA 手术（44 次白光，30 次 PDD）。患者的平均（范围）年龄为 77（52-95）岁。超过一半的患者有三种以上的合并症。既往肿瘤组织学分级为 G1pTa 至 T3。1 名患者出现血尿 1 周，自行缓解，无需住院治疗。无其他并发症。该手术患者耐受性良好，疼痛评分 0-2/10。使用 PDD 发现了 21%的患者有白光未发现的额外病变。3 个月时，行 OLA 后有 10.6%的白光患者和 4.3%的 PDD 患者复发。1 年后，65.1%和 46.9%的患者复发。OLA 的成本明显低于 IC（538 英镑 vs 1474 英镑），即使加上 PDD（912 英镑 vs 1844 英镑）也是如此。在患者的一生中，OLA 的临床效果（以质量调整生命年（QALY）衡量）优于 IC（0.147[标准差 0.059]），且成本更低（2576.42 英镑[标准差 7293.07 英镑]）。在国家卫生与保健卓越研究所（National Institute for Health and Care Excellence）设定的 30,000 英镑/QALY 的成本效益阈值下，OLA 具有 82%的成本效益概率。
这是第一项证明 OLA 治疗 NMIBC 的长期成本效益的研究。结果支持使用 OLA 治疗 NMIBC，尤其是在老年人中。
