Commentary on "economic and humanistic consequences of preventable bladder tumor
recurrences in nonmuscle invasive bladder cancer cases." Lee CT, Barocas D, Globe
DR, Oefelein MG, Colayco DC, Bruno A, O׳Day K, Bramley T, Department of Urology,
University of Michigan, Ann Arbor, MI.: J Urol 2012;188(6):2114-9. [Epub 2012 Oct
18]. doi: 10.1016/j.juro.2012.08.005.
Author(s): Hollenbeck BK.
Affiliation(s): Comment on
J Urol. 2012 Dec;188(6):2114-9.
Publication date & source: 2014, Urol Oncol. , 32(7):1089
PURPOSE: Perioperative intravesical chemotherapy following transurethral
resection of bladder tumor has been underused despite level 1 evidence supporting
its performance. The primary objective of this study was to estimate the economic
and humanistic consequences associated with preventable recurrences in patients
initially diagnosed with nonmuscle invasive bladder cancer.
MATERIALS AND METHODS: Using population based estimates of nonmuscle invasive
bladder cancer incidence, a 2-year model was developed to estimate the number of
preventable recurrences in eligible patients untreated with perioperative
intravesical chemotherapy. Therapy utilization rates were obtained from a
retrospective database analysis and a chart review study of 1,010 patients with
nonmuscle invasive bladder cancer. Recurrence rates of nonmuscle invasive bladder
cancer were obtained from a randomized clinical trial comparing transurethral
resection of bladder tumor with or without perioperative mitomycin C. Costs were
estimated using prevailing Medicare reimbursement rates. Quality adjusted
life-year estimates and disutilities for complications were obtained from the
literature.
RESULTS: The model estimated that 7,827 bladder recurrences could be avoided if
all patients received immediate intravesical chemotherapy. It estimated an
economic savings of $3,847 per avoidable recurrence, resulting in an aggregate
savings of $30.1 million. The model also estimated that 1,025 quality adjusted
life-years are lost every 2 years due to preventable recurrences, resulting in
0.13 quality adjusted life-years (48 quality adjusted days) lost per avoidable
recurrence. This translates into 0.02 quality adjusted life-years (8.1 quality
adjusted days) lost per patient not receiving immediate intravesical
chemotherapy.
CONCLUSIONS: Greater use of immediate intravesical chemotherapy in the United
States has the potential to substantially decrease the economic and humanistic
burdens of nonmuscle invasive bladder cancer.
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