Researchers have found that radical cystectomy (RC) offers better cost-effectiveness compared to trimodal therapy (TMT) for treating muscle-invasive bladder cancer (MIBC). This conclusion emerges from a comprehensive economic evaluation assessing treatments from a Medicare perspective over five and ten-year periods.
Economic Evaluation Methodology
The study utilized a health transition state microsimulation model, analyzing data from patients treated between 2005 and 2017. Focusing on an average 71-year-old patient with specific clinical-stage MIBC, the research excluded individuals unfit for RC, radiation, or cisplatin-based chemotherapy. Effectiveness was measured in quality-adjusted life years (QALYs), with a willingness-to-pay threshold set at $100,000 per QALY.
Findings on Cost and Effectiveness
Results indicated that TMT incurs an average additional cost of $30,525 compared to RC over five years, with QALYs slightly higher for TMT (3.94) than for RC (3.87). However, the incremental cost-effectiveness ratio (ICER) for TMT surpassed acceptable thresholds, rendering it not cost-effective at both five and ten-year horizons. Sensitivity analyses suggested that TMT could become viable if costs dropped below $17,605 or if metastasis-free survival improved by 11.6% over RC.
• TMT provides marginally higher quality-adjusted life years than RC.
• Significant cost differences make TMT less attractive economically.
• Potential cost reductions or survival improvements could alter TMT’s viability.
Developing policies to reduce the expenses associated with TMT could make it a more feasible option for patients. Additionally, accurately communicating the long-term side effects and expectations of TMT is crucial for informed, preference-sensitive decision-making.
Patients and healthcare providers must weigh the benefits of improved quality of life against the higher financial burden when considering treatment options. This study underscores the importance of economic evaluations in guiding clinical decisions and shaping healthcare policies to ensure both effective and sustainable cancer care strategies.
Implementing strategies to lower TMT costs could enhance its accessibility and acceptability among patients. Future research should explore avenues for cost reduction and further investigate the long-term outcomes of TMT to better inform treatment guidelines and patient choices.
Balancing economic factors with clinical benefits remains a key challenge in oncology, and studies like this play a vital role in optimizing treatment pathways for better patient outcomes and healthcare system sustainability.
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