Treatment of Nonmuscle Invading Bladder Cancer: Do Physicians in the United States Practice Evidence Based Medicine? The Use and Economic Implications of Intravesical Chemotherapy After Transurethral Resection of Bladder Tumors
Treatment of Nonmuscle Invading Bladder Cancer: Do Physicians in the United States Practice Evidence Based Medicine? The Use and Economic Implications of Intravesical Chemotherapy After Transurethral Resection of Bladder Tumors
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DOI：
10.1002/cncr.24311
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发表时间：
2009-06-15
期刊：
影响因子：
6.2
通讯作者：
Messing, Edward M.
中科院分区：
文献类型：
--
作者：
Madeb, Ralph;Golijanin, Dragan;Messing, Edward M.
背景技术背景：主要在美国境外进行的III期临床试验表明，经尿道膀胱切除术（TURB）后立即膀胱内灌注化疗可降低癌症复发率。作者试图确定美国泌尿科医生是否采用了这种做法，以及它对膀胱癌（BC）护理费用的潜在影响。方法：通过使用1997 - 2004年MED-STAT索赔数据，作者确定了接受膀胱镜活检或TURB的新诊断BC患者，以及在TURB后1天内接受膀胱内化疗的患者。使用已发表的疗效估计和医疗保险报销来模拟这种治疗与单纯TURB相比的经济后果。作者使用了3年的时间范围，并假设这种治疗适用于所有新诊断的低风险BC患者。结果：在1997年至2004年期间，作者确定了16,748例新诊断的BC患者，其中14,677例接受了膀胱镜活检或TURB。其中，只有49例（0.33%）接受了当天膀胱灌注化疗。从1997年到2004年，这种治疗方法的使用几乎没有变化。作者估计，与单纯TURB相比，TURB和立即膀胱内化疗治疗的每位患者3年节省538至690美元（10%至12%），反映了每年国家节省1980万至2480万美元。结论：TURB术后立即进行膀胱灌注化疗在美国尚未被接受。采取这一政策将大大降低不列颠哥伦比亚省护理的成本。Cancer 2009; 115：2660 - 70. (C)2009年美国癌症协会。
BACKGROUND: Phase 3 clinical trials performed primarily outside the US demonstrate that intravesical instillation of chemotherapy immediately after transurethral resection of the bladder (TURB) decreases cancer recurrence rates. The authors sought to determine whether US urologists have adopted this practice, and its potential effect on costs of bladder cancer (BC) care. METHODS: By using 1997-2004 MED-STAT claims data, the authors identified patients with newly diagnosed BC who underwent cystoscopic biopsy or TURB, and those who received intravesical chemotherapy within 1 day after TURB. Economic consequences of this treatment compared with TURB alone were modeled using published efficacy estimates and Medicare reimbursements. The authors used a time horizon of 3 years and assumed that this treatment was given for all newly diagnosed low-risk BC patients. RESULTS: Between 1997 and 2004, the authors identified 16,748 patients with newly diagnosed BC, of whom 14,677 underwent cystoscopic biopsy or TURB. Of these, only 49 (0.33%) received same-day intravesical instillation of chemotherapy. From 1997 through 2004, there has been little change in the use of this treatment. The authors estimated a 3-year savings of $538 to $690 (10% to 12%) per patient treated with TURB and immediate intravesical chemotherapy compared with TURB alone, reflecting a yearly national savings of $19.8 to $24.8 million. CONCLUSIONS: Instillation of intravesical chemotherapy immediately after TURB has not been embraced in the US. Adopting this policy would significantly lower the cost of BC care. Cancer 2009;115:2660-70. (C) 2009 American Cancer Society.