Hentschel Anouk E, Blankvoort Christian J, Bosschieter Judith, Vis André N, van Moorselaar R Jeroen A, Bosmans Judith E, Nieuwenhuijzen Jakko A
Department of Urology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.
Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Eur Urol Open Sci. 2022 Jan 17;37:7-13. doi: 10.1016/j.euros.2021.12.008. eCollection 2022 Mar.
Bladder cancer imposes a significant public health burden on the European Union. There is a need for cost-effective treatment and follow-up regimens.
To assess the cost-effectiveness of immediate mitomycin C (MMC) instillation within 1 d after surgery compared to delayed MMC instillation within 2 wk after surgery with further adjuvant treatment, depending on the patient's risk group.
This economic evaluation was based on a randomized controlled trial among 2243 Dutch patients with non-muscle-invasive bladder cancer (NMIBC) patients from a health care perspective over a 3-yr time period.
The treatment effect was measured as time to recurrence and recurrence-free survival. Missing effect data were imputed with multiple imputation. Health care utilization and related costs were estimated on the basis of treatment protocols for NMIBC patients in the Netherlands. Statistical uncertainty was estimated using bootstrapping and is graphically presented using cost-effectiveness planes and cost-effectiveness acceptability curves.
Time to recurrence was significantly longer for immediate MMC instillation (27.31 mo) than for delayed MMC instillation (24.97 mo), with an adjusted mean difference of 2.21 mo (95% confidence interval [CI] 1.58-2.84). The proportion of patients with recurrence-free survival was significantly higher after immediate MMC instillation (0.65) than after delayed MMC instillation (0.56), with an adjusted mean difference of 0.08 (95% CI 0.06-0.11). Total mean health care costs per patient were significantly lower for immediate MMC instillation (€22 959) than for delayed MMC instillation (€24 624), with an adjusted mean difference of -€1350 (95% CI -€1799 to -€900). The study is limited by the retrospective estimation of costs.
This trial-based cost-effectiveness analysis shows that from a health care perspective, immediate MMC instillation is more effective and less expensive compared to delayed MMC instillation.
We assessed the cost-effectiveness of immediate bladder instillation of mitomycin C after surgery to reduce the risk of recurrence after removal of the bladder tumor as compared to delayed instillation in a large Dutch population of patients with non-muscle-invasive bladder cancer. We found that immediate instillation was more effective and less expensive than delayed instillation. We conclude that immediate mitomycin C instillation is a cost-effective treatment for non-muscle-invasive bladder cancer.
膀胱癌给欧盟带来了沉重的公共卫生负担。因此需要具有成本效益的治疗和随访方案。
评估术后1天内立即膀胱灌注丝裂霉素C（MMC）与术后2周内延迟膀胱灌注MMC并根据患者风险组进行进一步辅助治疗相比的成本效益。
设计、设置和参与者：这项经济学评估基于一项随机对照试验，从卫生保健角度对2243例荷兰非肌层浸润性膀胱癌（NMIBC）患者进行了为期3年的研究。
治疗效果以复发时间和无复发生存率来衡量。缺失的效果数据采用多重填补法进行填补。根据荷兰NMIBC患者的治疗方案估算卫生保健利用率和相关成本。使用自抽样法估计统计不确定性，并通过成本效益平面和成本效益可接受性曲线以图形方式呈现。
立即膀胱灌注MMC组的复发时间（27.31个月）显著长于延迟膀胱灌注MMC组（24.97个月），调整后的平均差异为2.21个月（95%置信区间[CI]1.58 - 2.84）。立即膀胱灌注MMC组的无复发生存患者比例（0.65）显著高于延迟膀胱灌注MMC组（0.56），调整后的平均差异为0.08（95%CI 0.06 - 0.11）。立即膀胱灌注MMC组每位患者的总平均卫生保健成本（22959欧元）显著低于延迟膀胱灌注MMC组（24624欧元），调整后的平均差异为 - 1350欧元（95%CI - 1799至 - 900）。该研究受成本回顾性估计的限制。
这项基于试验的成本效益分析表明，从卫生保健角度来看，与延迟膀胱灌注MMC相比，立即膀胱灌注MMC更有效且成本更低。
我们评估了术后立即膀胱灌注丝裂霉素C与延迟灌注相比在降低荷兰大量非肌层浸润性膀胱癌患者膀胱肿瘤切除术后复发风险方面的成本效益。我们发现立即灌注比延迟灌注更有效且成本更低。我们得出结论，立即膀胱灌注丝裂霉素C是治疗非肌层浸润性膀胱癌的一种具有成本效益的方法。
