Division of Urology, Harvard Medical School, Brigham and Women's Hospital, 45 Francis Street, Boston, MA, 02115, USA.
Dana-Farber Cancer Institute, Boston, MA, USA.
World J Urol. 2019 Oct;37(10):2059-2065. doi: 10.1007/s00345-018-2550-x. Epub 2018 Nov 16.
Non-muscle-invasive bladder cancer (NMIBC) is a biologically heterogeneous disease and is one of the most expensive malignancies to treat on a per patient basis. In part, this high cost is attributed to the need for long-term surveillance. We sought to perform an economic analysis of surveillance strategies to elucidate cumulative costs for the management of NMIBC.
A Markov model was constructed to determine the average 5-year costs for the surveillance of patients with NMIBC. Patients were stratified into low, intermediate, and high-risk groups based on the EORTC risk calculator to determine recurrence and progression rates according to each category. The index patient was a compliant 65-year-old male. A total of four health states were utilized in the Markov model: no evidence of disease, recurrence, progression and cystectomy, and death.
Cumulative costs of care over a 5-year period were $52,125 for low-risk, $146,250 for intermediate-risk, and $366,143 for high-risk NMIBC. The primary driver of cost was progression to muscle-invasive disease requiring definitive therapy, contributing to 81% and 92% of overall cost for intermediate- and high-risk disease. Although low-risk tumors have a high likelihood of 5-year recurrence, the overall cost contribution of recurrence was 8%, whereas disease progression accounted for 71%.
Although protracted surveillance cystoscopy contributes to the expenditures associated with NMIBC, progression increases the overall cost of care across all three patient risk groups and most notably for intermediate- and high-risk disease patients.
非肌肉浸润性膀胱癌（NMIBC）是一种生物学异质性疾病，也是每位患者治疗费用最高的恶性肿瘤之一。部分原因是需要长期监测。我们旨在对监测策略进行经济分析，以阐明 NMIBC 管理的累积成本。
构建了一个马尔可夫模型来确定 NMIBC 患者监测的平均 5 年成本。根据 EORTC 风险计算器将患者分为低危、中危和高危组，以确定每个类别下的复发和进展率。指数患者为一名符合条件的 65 岁男性。马尔可夫模型共使用了四个健康状态：无疾病证据、复发、进展和膀胱切除术以及死亡。
5 年内的护理累计成本分别为低危组 52125 美元、中危组 146250 美元和高危组 366143 美元。成本的主要驱动因素是进展为需要确定性治疗的肌层浸润性疾病，占中危和高危疾病总费用的 81%和 92%。尽管低危肿瘤 5 年内复发的可能性很高，但复发的总费用贡献仅为 8%，而疾病进展占 71%。
尽管长期监测膀胱镜检查会增加与 NMIBC 相关的支出，但进展会增加所有三个患者风险组的整体护理成本，尤其是中危和高危疾病患者。
