Cost-effectiveness of neoadjuvant chemotherapy before radical cystectomy for muscle-invasive bladder cancer
Cost-effectiveness of neoadjuvant chemotherapy before radical cystectomy for muscle-invasive bladder cancer
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DOI：
10.1016/j.urolonc.2014.05.001
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发表时间：
2014-11-01
影响因子：
2.7
通讯作者：
McKiernan, James M.
中科院分区：
文献类型：
--
作者：
Stevenson, Scott M.;Danzig, Matthew R.;McKiernan, James M.
目的：为了确定治疗费用和生存期，调整生活质量，肌肉浸润性膀胱癌患者立即根治性化疗（RC）或与新辅助化疗（NAC）与后续RC的意图治疗。方法和材料：对我们的机构审查委员会批准的数据库进行回顾性审查，确定了肌肉-从2004年到2011年在我们机构治疗的浸润性膀胱癌。将患者分为单独接受RC的患者和计划RC前接受NAC的患者。NAC后拒绝RC的患者纳入意向治疗分析。生存期转换为质量调整生命年（QALY），每QALY的治疗费用determined.Results：共119例（65.4%）接受RC单独和63（34.6%）接受NAC，其中38人进行cyclohexane按计划。RC和NAC的平均总成本分别为42，890美元和52，429美元（P = 0.005）。单纯RC组和NAC组的5年总生存率分别为31.7%和42.5%（P = 0.034）。在QALOS中测量的仅RC组和NAC组的5年总生存率分别为21.9%和42.9%（P = 0.021）。NAC每增加一个生命年增加的成本为5，840美元（95%CI：1，772 - 9，909美元），每增加一个QALY增加的成本为6，187美元（95%CI：1，877 - 10，498美元）。每获得一个质量调整生命年的额外费用约为6，000美元。NAC的成本效用分析与其他癌症特异性治疗相比是有利的。(C)2014 Elsevier Inc. All rights reserved.
Objectives: To determine the costs of treatment and the duration of survival, adjusted for quality of life, for patients with muscle-invasive bladder cancer treated with immediate radical cystectomy (RC) or with neoadjuvant chemotherapy (NAC) with intent for subsequent RC.Methods and materials: A retrospective review of our institutional review board approved database identified patients with muscle-invasive bladder cancer treated at our institution from 2004 to 2011. Patients were divided into those receiving RC alone and those receiving NAC before planned RC. Patients who refused RC following NAC were included in an intention-to-treat analysis. Survival duration was converted to quality-adjusted life years (QALYs), and costs of treatment per QALY were determined.Results: A total of 119 patients (65.4%) received RC alone and 63 (34.6%) received NAC, 38 of whom proceeded to cystectomy as planned. Mean total costs were $42,890 and $52,429 for RC and NAC, respectively (P = 0.005). The 5-year overall survival was 31.7% and 42.5% for the RC-only group and the NAC group, respectively (P = 0.034). The 5-year overall survival measured in QALYs was 21.9% and 42.9% for the RC-only and the NAC groups, respectively (P = 0.021). The increased cost for NAC was $5,840 per additional life year gained (95% CI: $1,772-$9,909) and $6,187 per additional QALY gained (95% CI: $1,877-$10,498).Conclusions: The use of NAC is associated with a significant increase in quality-adjusted survival. The additional cost per QALY gained is approximately $6,000. The cost-utility analysis of NAC compares favorably with other cancer-specific therapies. (C) 2014 Elsevier Inc. All rights reserved.