Cost-effectiveness analysis of neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer.

258 Background: Neoadjuvant chemotherapy (NAC) is an option for treating muscle invasive bladder cancer (MIBC), and is reported to increase survival for patients who obtain a complete response with no residual disease at the time of radical cystectomy (RC). However, NAC has additional costs and side effects. We seek to compare the effectiveness of NAC and RC for MIBC and to report the increase in cost and change in quality adjusted life years (QALYs) for patients who receive NAC. Methods: Patients were retrospectively reviewed from 2004 to 2011 to identify those with MIBC (stage T2 to T4a) who were treated with either RC alone or NAC. Costs for hospital admissions and surgical procedures were estimated from the Healthcare Cost and Utilization Project (HCUP) using specific Diagnosis Related Groups (DRG) or ICD-9-CM identifiers. Costs for outpatient procedures and urology visits were obtained from internal billing departments, and costs for chemotherapy were estimated based on published literature. QALYs were calculated based on clinical events and standard utility weights obtained from the medical literature. Results: 186 patients were identified, of which 64% received RC alone and 36% received NAC. Overall median survival for the RC group and the NAC group was 26.6 months and 38.3 months, respectively (p=0.056). Overall median survival in QALYs for the RC group and NAC group was 21.9 months and 32.9 months, respectively (p=0.057). 5-year overall survival in QALYs was 21.8% for the RC group and 39.8% for the NAC group (p=0.039). The mean total cost of treatment during follow-up for the RC and NAC groups was $42,890 and $52,336, respectively. The absolute increase in cost of therapy for patients receiving NAC compared to RC alone was $9,712. The increased cost per additional QALY gained for patients receiving NAC was $10,317. Conclusions: Neoadjuvant chemotherapy results in an increased overall survival for patients with muscle invasive bladder cancer. This treatment is associated with an increased cost of approximately $10,000/QALY gained. This cost effectiveness compares favorably with other cancer therapies.