HEALTH-STATE COSTS OF HIGH-RISK NON-MUSCLE INVASIVE BLADDER CANCER IN PORTUGAL BASED ON EXPERT PANEL CONSENSUS
Author(s)
José Mariano, PharmD1, Susana Ferreira Santos, PharmD1, Catarina Pestana Silva, MSc2.
1J&J Innovative Medicine, Porto Salvo, Portugal, 2HE&OR Senior Researcher, ISBE, Lisboa, Portugal.
1J&J Innovative Medicine, Porto Salvo, Portugal, 2HE&OR Senior Researcher, ISBE, Lisboa, Portugal.
OBJECTIVES: High-risk non-muscle invasive bladder cancer (HR-NMIBC) is associated with intensive surveillance and interventions due to high recurrence rates. HR-NMIBC imposes a considerable burden on healthcare systems and patients. In Portugal, evidence on HR-NMIBC costs remains very limited. We aimed to estimate the costs associated with HR-NMIBC health states in Portugal.
METHODS: Costs were estimated for the health states: on-treatment with intravesical Bacillus Calmette-Guérin (BCG), disease-free surveillance after BCG, post-radical cystectomy, metastatic disease (progression-free and post-progression), and end-of-life. A societal perspective was adopted, incorporating direct costs (medical and non-medical) and indirect costs (human capital approach). Healthcare resource utilization was estimated by an expert panel comprising seven urologists/oncologists. Unit costs obtained from official national sources. Drug acquisition/administration costs were included. All costs reported in 2026 euros.
RESULTS: According to expert panel, 77% of bladder cancers are diagnosed as NMIBC, of which 32% are HR-NMIBC (75% male, mean age 66 years, 57% employed at diagnosis). Of those, 90% receive frontline BCG therapy and 10% undergo immediate radical cystectomy. Mean cost of BCG induction followed by maintenance therapy and management of treatment-related complications was estimated at €4,589/patient, considering expert panel-estimated discontinuation rates of 35% after first year and 64% after second year. Annual cost of disease-free surveillance following BCG was estimated at €1,442/patient at year 1-2, €965/patient during years 3-5 and €623/patient thereafter. Cost associated with radical cystectomy reached up to €54,013/patient with surgical procedure representing 40% of total costs. Following progression to metastatic disease, average treatment costs (first- and second-line) were estimated at €58,506/patient with annual follow-up costs estimated at €4,603/patient while progression-free and €7,049/patient after disease progression. End-of-life costs were estimated at €4,815
CONCLUSIONS: These results highlight the substantial impact of radical cystectomy and disease progression on healthcare-related costs and support future cost-of-illness modelling to improve understanding of the economic burden associated with HR-NMIBC.
METHODS: Costs were estimated for the health states: on-treatment with intravesical Bacillus Calmette-Guérin (BCG), disease-free surveillance after BCG, post-radical cystectomy, metastatic disease (progression-free and post-progression), and end-of-life. A societal perspective was adopted, incorporating direct costs (medical and non-medical) and indirect costs (human capital approach). Healthcare resource utilization was estimated by an expert panel comprising seven urologists/oncologists. Unit costs obtained from official national sources. Drug acquisition/administration costs were included. All costs reported in 2026 euros.
RESULTS: According to expert panel, 77% of bladder cancers are diagnosed as NMIBC, of which 32% are HR-NMIBC (75% male, mean age 66 years, 57% employed at diagnosis). Of those, 90% receive frontline BCG therapy and 10% undergo immediate radical cystectomy. Mean cost of BCG induction followed by maintenance therapy and management of treatment-related complications was estimated at €4,589/patient, considering expert panel-estimated discontinuation rates of 35% after first year and 64% after second year. Annual cost of disease-free surveillance following BCG was estimated at €1,442/patient at year 1-2, €965/patient during years 3-5 and €623/patient thereafter. Cost associated with radical cystectomy reached up to €54,013/patient with surgical procedure representing 40% of total costs. Following progression to metastatic disease, average treatment costs (first- and second-line) were estimated at €58,506/patient with annual follow-up costs estimated at €4,603/patient while progression-free and €7,049/patient after disease progression. End-of-life costs were estimated at €4,815
CONCLUSIONS: These results highlight the substantial impact of radical cystectomy and disease progression on healthcare-related costs and support future cost-of-illness modelling to improve understanding of the economic burden associated with HR-NMIBC.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE688
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis, Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology, Urinary/Kidney Disorders