title: Contemporary cost-effectiveness analysis comparing sequential bacillus Calmette-Guerin and electromotive mitomycin versus bacillus Calmette-Guerin alone for patients with high-risk non-muscle-invasive bladder cancer.
abstract: BACKGROUND
  Sequential bacillus Calmette-Guerin (BCG) and electromotive mitomycin (sequential therapy) have been shown in a randomized prospective trial to be superior to therapy with BCG alone in patients with high-risk non-muscle-invasive bladder cancer. The objective of the current study was to compare the costs and benefits of these 2 treatment strategies by performing a 5-year and 10-year cost-effectiveness study.
  
  
  METHODS
  A Markov model was developed to estimate the incremental cost-effectiveness ratio over a 5-year and 10-year period. Estimates of disease progression, death, and treatment efficacy were obtained from what to the authors' knowledge is the only randomized trial comparing the 2 therapies. Costs included: 1) medical costs (physician fees); 2) drug costs (preparation and instillation); and 3) hospital costs (procedure fees, admission fees, and tests and procedures done during surveillance). Patients were allowed a second course of induction therapy.
  
  
  RESULTS
  Sequential therapy was found to be associated with a higher initial material cost for induction and maintenance. The average effectiveness for the patients treated with therapy with BCG alone was 4.39 years with a mean cost of $9236 (95% confidence interval, $9118-$9345) per patient. The sequential group resulted in an average effectiveness of 4.65 years, with a mean cost of $16,468 (95% confidence interval, $16,371-$16,527). The 5-year incremental cost-effectiveness ratio of sequential versus BCG-alone therapy was $27,815 per life-year gained. The corresponding figure over a 10-year period was $8618 per life-year gained.
  
  
  CONCLUSIONS
  The results of the current study suggest that sequential therapy is a cost-effective treatment for patients with high-risk non-muscle-invasive bladder cancer.
authors.affiliation: Division of Urology, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Bassel G
authors.initials: BG
authors.lastname: Bachir
authors.forename: Alice
authors.initials: A
authors.lastname: Dragomir
authors.forename: Armen G
authors.initials: AG
authors.lastname: Aprikian
authors.forename: Simon
authors.initials: S
authors.lastname: Tanguay
authors.forename: Adrian
authors.initials: A
authors.lastname: Fairey
authors.forename: Girish S
authors.initials: GS
authors.lastname: Kulkarni
authors.forename: Rodney H
authors.initials: RH
authors.lastname: Breau
authors.forename: Peter C
authors.initials: PC
authors.lastname: Black
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D001500:BCG Vaccine / Q000008:administration & dosage / Q000191:economics*; D002170:Canada; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D006801:Humans; D016233:Immunotherapy, Active / Q000191:economics / Q000379:methods; D008390:Markov Chains; D016685:Mitomycin / Q000008:administration & dosage / Q000191:economics*; D018803:Models, Economic; D009010:Monte Carlo Method; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D006113:United Kingdom; D014481:United States; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000191:economics / Q000628:therapy*
chemical_list: D001500:BCG Vaccine; D016685:Mitomycin
keywords: bacillus Calmette-Guerin (BCG); cost-effectiveness; electromotive mitomycin; non-muscle invasive bladder cancer; sequential therapy