A Cost-effectiveness Analysis of Management of Low-risk Non–muscle-invasive Bladder Cancer Using Office-based Fulguration

Lee, Richard; Chughtai, Bilal; Donat, S. Machele; Sandhu, Jaspreet S.; Herr, Harry W.

doi:10.1016/j.urology.2014.09.041

Cited by 28 publications

(11 citation statements)

References 15 publications

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“…Therefore, further studies and new research methods could be meaningful to this unsolved problem. The Markov model mentioned in this article is generally used in medical decision making these years [ 19 – 22 ]. A Markov model arranges patients in different health states in the corresponding Markov states according to the natural disease history.…”

Section: Discussionmentioning

confidence: 99%

“…The Markov model is capable of estimating a disease’s outcome by simulating disease progression where patients move through different health states over the preset cycles. It has been successfully used in the simulation of a head-to-head comparison of treatment efficacy [ 19 – 22 ]. In this article, we constructed a Markov model to make a comparison of efficacy between full dose BCG treatment and one-third dose BCG treatment for patients with intermediate and high-risk NMIBC.…”

Section: Introductionmentioning

confidence: 99%

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Low-dose Bacillus Calmette-Guerin versus full-dose for intermediate and high-risk of non-muscle invasive bladder cancer: a Markov model

et al. 2018

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BackgroundTo compare the efficacy of low dose (27 mg) Bacillus Calmette-Guérin (BCG) and a full dose (81 mg) BCG immunotherapy for patients with intermediate and high-risk non-muscle invasive bladder cancer (NMIBC) after a typical transurethral bladder resection.MethodsWe constructed a Markov model for a 20-year simulation of the disease to compare the overall survival of patients with intermediate and high-risk of NMIBC between the full-dose therapy (FD group) and the low-dose therapy (LD group). Base case analysis, one-way and two-way sensitivity analysis and a second-order Monte Carlo analysis were performed based on data from 15 published articles.ResultsThe expected overall survivals were 9.56 (9.55–9.57) years for FD group and 9.63 (9.61–9.64) years for LD group(P < 0.001). The estimated mortality in the FD group at 5, 10, and 20 years were 34.23%, 57.51% and 83.14%, respectively. The corresponding values in the LD group were 34.11%, 57.17%, 82.16%, respectively. Age-specific mortality and metastatic rate after undergoing radical cystectomy (RC) were the most two sensitive parameters in both groups. The rate of disease recurrence with disease worsening is the determining factor when choosing the optimal dose of BCG treatment.ConclusionsA low-dose BCG treatment may act slightly better than a full-dose BCG treatment for patients with intermediate and high-risk of NMIBC. This finding will require further high-quality studies to validate.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-4988-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Low-dose Bacillus Calmette-Guerin versus full-dose for intermediate and high-risk of non-muscle invasive bladder cancer: a Markov model

et al. 2018

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“…In two European trials using laser photocoagulation techniques under local anaesthesia, savings of up to €2000 per procedure could be realized compared to TURBT . A US‐based cost‐analysis model from the Memorial‐Sloan Kettering Cancer Centre found that, despite a small absolute difference of only $37 per quality‐adjusted life‐years favouring office fulguration over outpatient TURBT, the long‐term follow‐up and protracted course of low‐grade BCa would result in significant overall cost savings .…”

Section: Managementmentioning

confidence: 99%

Risk‐adapted management of low‐grade bladder tumours: recommendations from the International Bladder Cancer Group (IBCG)

et al. 2020

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Objective To provide a contemporary update and recommendations for the diagnosis and management of low‐grade non‐muscle‐invasive bladder cancer (BCa) based on current literature and expert consensus of the International Bladder Cancer Group. Methods We reviewed published trials, guidelines, meta‐analyses and reviews (up to March 2019) and provide recommendations on baseline evaluations, treatment, endpoints, study design and surveillance protocols. Results Low‐grade Ta BCa poses minimal risk to patients in terms of progression and disease‐specific survival. Thus, to minimize patient morbidity, this entity should be managed appropriately. After initial diagnosis of low‐grade Ta tumour, subsequent stable, low‐grade‐appearing recurrences can be managed conservatively with office cystoscopy and fulguration or even followed using an active surveillance protocol. Intravesical therapy other than single‐dose peri‐operative chemotherapy instillation should be used judiciously, and only after assigning appropriate risk points. Routine use of urinary cytology – other than at initial risk stratification, or for patients on active surveillance without therapy – is not recommended; and surveillance cystoscopy may be discontinued after 5 years. Clinical studies in this group of patients should focus on recurrence rates, and time to recurrence, rather than progression events. Conclusions The International Bladder Cancer Group has developed formal recommendations regarding the diagnosis, treatment and surveillance of low‐grade non‐muscle‐invasive BCa to minimize morbidity and encourage uniformity among studies in this disease.

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“…Some authors described office-based tumors fulguration (36). This method may be a better method of choice in order to reduce the need of TURBTs for patients.…”

Section: Discussionmentioning

confidence: 99%

Active surveillance for non-muscle invasive bladder cancer

Marcq

Hénon

Ouzaïd

et al. 2019

Transl. Androl. Urol

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Most of low grade (LG) bladder tumors will experience disease recurrence and very few of them (<2%) will experience disease progression. Therefore active surveillance (AS) for LG non-muscle invasive bladder cancer (NMIBC) has emerged. The goal of our study was to provide a literature review of AS for LG NMIBC including inclusion criteria, modalities and oncological outcomes. We conducted a systematic review (registered in PROSPERO: CRD42018102935) using MEDLINE and EMBASE between June 2018 and August 2018 with the following terms: LG, NMIBC, AS, urothelial neoplasm. Overall, 6 studies that reached our scope of review were included cumulating 403 patients with 2 prospective trials. Inclusion criteria were: recurrent LG (G1 and G2) Ta or T1 NMIBC, with a negative cytology, a low volume (<10 mm) and low number (<5) of tumors. Cystoscopy every 3 months during the first 2 years and every 6 months afterwards were required. AS dropout criteria were presence of tumor-related symptoms, a positive cytology, a modification of tumor morphology or size and patient’s request. Pooled data showed an overall 65% reclassification rate where 15% of patients were reclassified based on grade and 10% on stage with a median follow-up of 32 months (IQR, 24–42 months). Only one study reported on progression to MIBC in 4 patients out of 186 (2%). Most of patients enrolled in an AS protocol for recurrent LG NMIBC will undergo a TURBT eventually. Many patients may be eligible to this therapeutic approach but current knowledge does not support its use in daily practice outside of a clinical trial.

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A Cost-effectiveness Analysis of Management of Low-risk Non–muscle-invasive Bladder Cancer Using Office-based Fulguration

Cited by 28 publications

References 15 publications

Low-dose Bacillus Calmette-Guerin versus full-dose for intermediate and high-risk of non-muscle invasive bladder cancer: a Markov model

Low-dose Bacillus Calmette-Guerin versus full-dose for intermediate and high-risk of non-muscle invasive bladder cancer: a Markov model

Risk‐adapted management of low‐grade bladder tumours: recommendations from the International Bladder Cancer Group (IBCG)

Active surveillance for non-muscle invasive bladder cancer

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