Cost-Utility Analysis of Dose-Dense Methotrexate, Vinblastine, Doxorubicin, and Cisplatin Chemotherapy Regimen in Comparison With Gemcitabine and Cisplatin Chemotherapy Regimen in the Treatment of Patients With Muscle Invasive Bladder Cancer in Iran.

OBJECTIVES

Bladder cancer incurs the highest lifetime treatment cost per patient among various cancers. Current guidelines endorse several cisplatin-based regimens as neoadjuvant chemotherapy. This cost-utility analysis aimed to compare 2 primary neoadjuvant chemotherapy regimens-dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (dd-MVAC) and gemcitabine and cisplatin (GC)-for patients with muscle-invasive bladder cancer, providing economic evidence to inform treatment guidelines in Iran.

METHODS

A Markov decision model was constructed, incorporating 4 states: after radical cystectomy without recurrence, no radical cystectomy, recurrence, and death over a lifetime horizon. Clinical outcomes were derived from the VESPER (French Genito-Urinary Tumor Group and French Association of Urology V05) phase 3 randomized controlled trial, whereas costs were obtained from local Iranian data. The main result involved determining an incremental cost-effectiveness ratio within the simulated population, with a willingness-to-pay threshold of 1656 USD (equivalent to Iran's gross domestic product per capita in 2023). Costs and benefits were discounted at 5.8% per annum, and probabilistic and univariate deterministic sensitivity analyses were conducted.

RESULTS

From the perspective of the Iranian healthcare payer, 6 cycles of dd-MVAC yielded 0.02 greater quality-adjusted life-years compared with 4 cycles of GC, resulting in a cost saving of 1 173 491 USD and an incremental cost-effectiveness ratio of -78 708 870. Consequently, dd-MVAC emerged as the dominant option over a lifetime horizon (23 years). The model proved most sensitive to variations in recurrence and toxicity probabilities during treatment.

CONCLUSIONS

Based on this study's results, dd-MVAC represents a cost-saving treatment regimen per patient in the Iranian health system compared with GC, with superior utility.