title: [Analysis of budgetary impact of moderate and high risk non muscle-invasive bladder cancer by means of neoadjuvant hyperthermia chemotherapy compared to the standard adjuvant treatment with BCG].
abstract: OBJECTIVE
  To study the relationship between cost-effectiveness and budgetary impact the application of a neoadjuvant chemo-hyperthermia treatment on 15 patients with NMI multi-recurrent bladder cancer and/or whose risk of recurrence and progression is medium-high, compared with the standard neoadjuvant BCG treatment, has had on the Hospital Comarcal de Monforte de Lemos (Lugo).
  
  
  METHODS
  A model was designed from an SNS perspective with a temporary horizon of three years to compare the costs of applying neoadjuvant chemo-hyperthermia on the patients of the clinical test (8 instillations weekly of 80 mg Mitomycin C recirculating at 43 C for an hour prior to carrying out a transurethral resection of the bladder tumor) with the costs of treating 15 patients with the same risk profile with the standard adjuvant treatment of BCG (control group). The effective available costs corresponding to drugs, disposables and those relative to TURBT, cold biopsy and tumor relapse were included. The costs of diagnostic tests and follow-up were discarded from the model because they did not vary between groups.
  
  
  RESULTS
  The model built with effective and published cost data establishes a favourable difference in favour of the neoadjuvant treatment with chemo hyperthermia in terms of 3 year costs with a minimum global savings of 10,300€ and 687€ per patient, together with an improvement in the effectiveness of the treatment. These values could reach a minimum savings of 25,960€ and 1,731€ per patient, if a change in protocol is made after the neoadjuvant treatment, which uses the cold biopsy to check the results. Of the 15 patients pre-treated with chemo-hyperthermia, 11 high-risk and 4 medium-risk, 9 have responded completely (absence of residual tumor) and 6 partially (shrinking of the tumor). The number of expected relapses has been reduced from 8 to 2 and progression from 3 to 0.
  
  
  CONCLUSIONS
  The neoadjuvant treatment with chemo hyperthermia constitutes a cost-effective therapeutic strategy.
authors.affiliation: Servicio de Urología. Hospital Comarcal de Monforte. Monforte de Lemos. Lugo. España.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Sousa
authors.affiliation: Servicio de Urología. Hospital Comarcal de Monforte. Monforte de Lemos. Lugo. España.
authors.forename: Idelfonso
authors.initials: I
authors.lastname: Piñeiro
authors.affiliation: Servicio de Urología. Hospital Comarcal de Monforte. Monforte de Lemos. Lugo. España.
authors.forename: Vicente
authors.initials: V
authors.lastname: Aparici
authors.affiliation: Servicio de Urología. Hospital Comarcal de Monforte. Monforte de Lemos. Lugo. España.
authors.forename: Pilar
authors.initials: P
authors.lastname: Neira
authors.affiliation: Servicio de Urología. Hospital Comarcal de Monforte. Monforte de Lemos. Lugo. España.
authors.forename: Víctor
authors.initials: V
authors.lastname: Monserrat
authors.affiliation: Servicio de Urología. Hospital Comarcal de Monforte. Monforte de Lemos. Lugo. España.
authors.forename: Carlos
authors.initials: C
authors.lastname: Uribarri
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001500:BCG Vaccine / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D018570:Risk Assessment; D001749:Urinary Bladder Neoplasms / Q000191:economics* / Q000473:pathology / Q000628:therapy*
chemical_list: D000276:Adjuvants, Immunologic; D000970:Antineoplastic Agents; D001500:BCG Vaccine