Creation of a Novel Canadian Policy Model for Bladder Cancer
Author(s)
Douglas C. Cheung, MD1, JACQUELINE A. MAY, PhD2, Karen E. Bremner, BSc1, Mia Papasideris, MSc1, Peter Black, MD3, Wassim Kassouf, MD4, William WL Wong, PhD5, Girish S. Kulkarni, MD PhD FRCSC1;
1Princess Margaret Cancer Centre, Department of Surgery, Division of Urology, Toronto, ON, Canada, 2University of Waterloo, Waterloo, ON, Canada, 3University of British Columbia, Vancouver, BC, Canada, 4McGill University Health Center, Department of Surgery, Montreal, QC, Canada, 5University of Waterloo, School of Pharmacy, Waterloo, ON, Canada
1Princess Margaret Cancer Centre, Department of Surgery, Division of Urology, Toronto, ON, Canada, 2University of Waterloo, Waterloo, ON, Canada, 3University of British Columbia, Vancouver, BC, Canada, 4McGill University Health Center, Department of Surgery, Montreal, QC, Canada, 5University of Waterloo, School of Pharmacy, Waterloo, ON, Canada
Presentation Documents
OBJECTIVES: Many promising, yet expensive, therapies have recently been approved in the diagnosis and treatment of bladder cancer (BCa) patients. Our goal is to create a unified single-platform Canadian Policy Model (CPM) that can evaluate the cost-effectiveness of new and emerging therapies to inform decision modelling and policy work.
METHODS: The CPM is a patient-level state-transition model developed in R. It is comprised of three modules representing the natural history of BCa: non-muscle invasive, muscle invasive, and metastatic disease. Simulated patients move through health states that reflect the disease journey within these modules including diagnosis, localized treatment, surgical, radiation, and systemic treatment options, surveillance, and best supportive care. As new therapies are approved, they can be added to the CPM to assess their cost-effectiveness relative to one another and the standard of care.
RESULTS: After identifying 17 health states, overall model structure and transitions were refined through an iterative review by clinicians and stakeholders to create the model. Model inputs were then obtained for utilities (prospective evaluation of 406 BCa patients from three Canadian centres), costs (Ontario ICES administrative data algorithms), and transition probabilities (literature review and administrative data). In addition to face and clinical validity, the model was then externally validated in a sequential fashion starting with systemic treatment in metastatic disease (bottom-up approach) against existing decision models.
Finally, the CPM has been successively presented and revised based on feedback from bi-annual knowledge translation and stakeholder meetings with patient advocates, decision modellers, health economists, and members of provincial and national health agencies.
CONCLUSIONS: The CPM is a novel decision modelling platform reflecting the trajectory of bladder cancer care. We are now finalizing and validating disease modules after completing the prospective utility study and literature reviews. Once complete, this model will serve as a Canadian-based reference available for decision modelling agencies and policy makers.
METHODS: The CPM is a patient-level state-transition model developed in R. It is comprised of three modules representing the natural history of BCa: non-muscle invasive, muscle invasive, and metastatic disease. Simulated patients move through health states that reflect the disease journey within these modules including diagnosis, localized treatment, surgical, radiation, and systemic treatment options, surveillance, and best supportive care. As new therapies are approved, they can be added to the CPM to assess their cost-effectiveness relative to one another and the standard of care.
RESULTS: After identifying 17 health states, overall model structure and transitions were refined through an iterative review by clinicians and stakeholders to create the model. Model inputs were then obtained for utilities (prospective evaluation of 406 BCa patients from three Canadian centres), costs (Ontario ICES administrative data algorithms), and transition probabilities (literature review and administrative data). In addition to face and clinical validity, the model was then externally validated in a sequential fashion starting with systemic treatment in metastatic disease (bottom-up approach) against existing decision models.
Finally, the CPM has been successively presented and revised based on feedback from bi-annual knowledge translation and stakeholder meetings with patient advocates, decision modellers, health economists, and members of provincial and national health agencies.
CONCLUSIONS: The CPM is a novel decision modelling platform reflecting the trajectory of bladder cancer care. We are now finalizing and validating disease modules after completing the prospective utility study and literature reviews. Once complete, this model will serve as a Canadian-based reference available for decision modelling agencies and policy makers.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE132
Topic
Economic Evaluation
Disease
SDC: Oncology, SDC: Urinary/Kidney Disorders, STA: Surgery