COST-EFFECTIVENESS OF BLADDER-PRESERVING TREATMENT VERSUS RADICAL CYSTECTOMY IN MUSCLE-INVASIVE BLADDER CANCER: A DUTCH REAL-WORLD HEALTH ECONOMIC ANALYSIS
Author(s)
Leonie van Bemmelen1, Emma Palsma, MsC2, Martine Hoogendoorn, PhD3, Valérie Johanna van Hezik-Wester, PhD4, Richard Meijer, M.D. PhD5, Joost Boormans, M.D. PhD6, Lambertus Kiemeney, PhD7, Alfred Witjes, M.D. PhD7, Lisa van Hoogstraten, PhD7, Annemarie Leliveld, M.D. PhD8, Martine Franckena, M.D. PhD9, Elzbieta van der Steen - Banasik, M.D. MsC10, Geert Smits, PhD, MD11, Maarten Hulshof, M.D. PhD12, K.K.H. Aben, PhD13, Katharina Brück, M.D. PhD12, Carin Uyl-De Groot, Sr., PhD14.
1researcher, iMTA, Netherlands, 2iMTA - Erasmus University Rotterdam, Rotterdam, Netherlands, 3iMTA, Rotterdam, Netherlands, 4Erasmus University, 's-Hertogenbosch, Netherlands, 5University Medical Center Utrecht, Utrecht, Netherlands, 6Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands, 7Radboud University Medical Center, Nijmegen, Netherlands, 8University Medical Center Groningen, Groningen, Netherlands, 9Erasmus Medical Center, Rotterdam, Netherlands, 10Radiotherapie groep, Arnhem, Netherlands, 11Rijnstate ziekenhuis, Arnhem, Netherlands, 12Amsterdam UMC, Amsterdam, Netherlands, 13Department for Health Evidence, Radboud university medical center, Nijmegen, Netherlands, 14ESHPM/iMTA Erasmus University Rotterdam, Rotterdam, Netherlands.
1researcher, iMTA, Netherlands, 2iMTA - Erasmus University Rotterdam, Rotterdam, Netherlands, 3iMTA, Rotterdam, Netherlands, 4Erasmus University, 's-Hertogenbosch, Netherlands, 5University Medical Center Utrecht, Utrecht, Netherlands, 6Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands, 7Radboud University Medical Center, Nijmegen, Netherlands, 8University Medical Center Groningen, Groningen, Netherlands, 9Erasmus Medical Center, Rotterdam, Netherlands, 10Radiotherapie groep, Arnhem, Netherlands, 11Rijnstate ziekenhuis, Arnhem, Netherlands, 12Amsterdam UMC, Amsterdam, Netherlands, 13Department for Health Evidence, Radboud university medical center, Nijmegen, Netherlands, 14ESHPM/iMTA Erasmus University Rotterdam, Rotterdam, Netherlands.
OBJECTIVES: Bladder-preserving treatment (BPT) for non-metastatic muscle-invasive bladder cancer (MIBC) has become an alternative to recommended radical cystectomy (RC), which is associated with substantial post-operative morbidity. While survival appears comparable, evidence on cost-effectiveness in the European setting is lacking. This study evaluated the cost-effectiveness of BPT, comprising trimodal therapy (TMT) or brachytherapy (BT), versus RC from a Dutch societal perspective, using real-world data.
METHODS: A partitioned survival model with four health states (disease-free, local/regional recurrence, distant metastasis, and death) was developed with a one-month cycle length. Clinical and economic inputs were primarily derived from the CRAC study, a Dutch population-based observational study comparing BPT (n=331) and RC (n=1,101) in MIBC patients using Netherlands Cancer Registry data. Survival extrapolation was based on the full study population, while healthcare resource use was obtained from electronic hospital records in a patient subset. Utility values were obtained by mapping EORTC QLQ-C30 scores to EQ-5D, using a validated algorithm. Unit costs were sourced from Dutch national reimbursement tariffs and the Dutch costing manual. Uncertainty around the input parameters was explored through univariate and probabilistic sensitivity analyses.
RESULTS: Extrapolated curves indicated a small survival benefit for BPT up to 5-years, with RC having higher survival rates thereafter. Over a 5-year horizon, both TMT and BT were dominant over RC, yielding gains of 0.22 QALYs with cost savings of €17,554 (TMT) and €16,945 (BT), driven largely by avoided stoma-related costs. Over a lifetime horizon, TMT and BT resulted in QALY losses of 0.45, but remained cost-saving, with savings per QALY lost of €142,127 (TMT) and €120,905 (BT), both exceeding the Dutch €50,000 threshold. Results were robust across all sensitivity analyses.
CONCLUSIONS: Based on real-world evidence, BPT (whether as TMT or BT) seems to be a cost-effective treatment strategy compared to RC for MIBC patients in the Netherlands.
METHODS: A partitioned survival model with four health states (disease-free, local/regional recurrence, distant metastasis, and death) was developed with a one-month cycle length. Clinical and economic inputs were primarily derived from the CRAC study, a Dutch population-based observational study comparing BPT (n=331) and RC (n=1,101) in MIBC patients using Netherlands Cancer Registry data. Survival extrapolation was based on the full study population, while healthcare resource use was obtained from electronic hospital records in a patient subset. Utility values were obtained by mapping EORTC QLQ-C30 scores to EQ-5D, using a validated algorithm. Unit costs were sourced from Dutch national reimbursement tariffs and the Dutch costing manual. Uncertainty around the input parameters was explored through univariate and probabilistic sensitivity analyses.
RESULTS: Extrapolated curves indicated a small survival benefit for BPT up to 5-years, with RC having higher survival rates thereafter. Over a 5-year horizon, both TMT and BT were dominant over RC, yielding gains of 0.22 QALYs with cost savings of €17,554 (TMT) and €16,945 (BT), driven largely by avoided stoma-related costs. Over a lifetime horizon, TMT and BT resulted in QALY losses of 0.45, but remained cost-saving, with savings per QALY lost of €142,127 (TMT) and €120,905 (BT), both exceeding the Dutch €50,000 threshold. Results were robust across all sensitivity analyses.
CONCLUSIONS: Based on real-world evidence, BPT (whether as TMT or BT) seems to be a cost-effective treatment strategy compared to RC for MIBC patients in the Netherlands.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE387
Topic
Economic Evaluation, Real World Data & Information Systems
Disease
Oncology