Luca Afferi, Beate Jahn, Amar H Kelkar, Stijntje W Dijk, Zach M Feldman, Zachary J Ward, Marco Moschini, Richard Cathomas, Joaquim Bellmunt, Andrea Gallioli, Alberto Breda, Christian D Fankhauser, Agostino Mattei, Steven L Chang, Uwe Siebert
{"title":"Perioperative cisplatin-based chemotherapy for muscle-invasive bladder cancer: a decision analysis.","authors":"Luca Afferi, Beate Jahn, Amar H Kelkar, Stijntje W Dijk, Zach M Feldman, Zachary J Ward, Marco Moschini, Richard Cathomas, Joaquim Bellmunt, Andrea Gallioli, Alberto Breda, Christian D Fankhauser, Agostino Mattei, Steven L Chang, Uwe Siebert","doi":"10.1007/s00345-025-05584-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>While meta-analyses of randomised studies suggest that neoadjuvant (NAC) or adjuvant (ACT) cisplatin-based chemotherapy improve overall survival in patients with muscle-invasive bladder cancer (MIBC), there are no trials comparing NAC against ACT in terms of quality-adjusted life years (QALYs) and costs. We aimed to evaluate the long-term QALYs, costs, and cost-effectiveness of different strategies for treating patients with MIBC.</p><p><strong>Methods: </strong>An individual-level state transition microsimulation model was developed for patients with urothelial non-metastatic MIBC eligible for surgery and NAC at diagnosis. Four treatment strategies were evaluated: (i) no treatment, (ii) radical cystectomy (RC) without perioperative chemotherapy, (iii) NAC followed by RC, and (iv) RC followed by ACT. Primary endpoints were QALYs and costs. Sensitivity analysis on the probability of being fit for ACT after surgery was conducted to account for the uncertainty of this parameter. The model was face-validated independently by two urologists.</p><p><strong>Results: </strong>Life-expectancy was 4.54 QALYs for ACT, 4.38 QALYs for NAC, 4.28 QALYs for RC without perioperative chemotherapy, and 2.84 QALYs for no treatment. Costs were lowest for ACT (US$45,805), compared to NAC (US$48,160), RC without perioperative chemotherapy (US$48,703), and no treatment (US$59,948). Sensitivity analysis suggested that NAC is associated with increased QALYs compared to ACT if the estimated probability of being fit for ACT is less than 38%. Limitations include the US-centric cost perspective.</p><p><strong>Conclusions: </strong>In lack of comparative studies, simulated data suggests that ACT leads to increased QALYs and is cost-effective compared to NAC.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"197"},"PeriodicalIF":2.8000,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Urology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00345-025-05584-7","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: While meta-analyses of randomised studies suggest that neoadjuvant (NAC) or adjuvant (ACT) cisplatin-based chemotherapy improve overall survival in patients with muscle-invasive bladder cancer (MIBC), there are no trials comparing NAC against ACT in terms of quality-adjusted life years (QALYs) and costs. We aimed to evaluate the long-term QALYs, costs, and cost-effectiveness of different strategies for treating patients with MIBC.
Methods: An individual-level state transition microsimulation model was developed for patients with urothelial non-metastatic MIBC eligible for surgery and NAC at diagnosis. Four treatment strategies were evaluated: (i) no treatment, (ii) radical cystectomy (RC) without perioperative chemotherapy, (iii) NAC followed by RC, and (iv) RC followed by ACT. Primary endpoints were QALYs and costs. Sensitivity analysis on the probability of being fit for ACT after surgery was conducted to account for the uncertainty of this parameter. The model was face-validated independently by two urologists.
Results: Life-expectancy was 4.54 QALYs for ACT, 4.38 QALYs for NAC, 4.28 QALYs for RC without perioperative chemotherapy, and 2.84 QALYs for no treatment. Costs were lowest for ACT (US$45,805), compared to NAC (US$48,160), RC without perioperative chemotherapy (US$48,703), and no treatment (US$59,948). Sensitivity analysis suggested that NAC is associated with increased QALYs compared to ACT if the estimated probability of being fit for ACT is less than 38%. Limitations include the US-centric cost perspective.
Conclusions: In lack of comparative studies, simulated data suggests that ACT leads to increased QALYs and is cost-effective compared to NAC.
期刊介绍:
The WORLD JOURNAL OF UROLOGY conveys regularly the essential results of urological research and their practical and clinical relevance to a broad audience of urologists in research and clinical practice. In order to guarantee a balanced program, articles are published to reflect the developments in all fields of urology on an internationally advanced level. Each issue treats a main topic in review articles of invited international experts. Free papers are unrelated articles to the main topic.