OBJECTIVES: First-line treatments for high-risk non-muscle invasive bladder cancer (NMIBC) include transurethral resection of the bladder tumour and Bacillus Calmette-Guerin (BCG) intravesical therapy. If BCG therapy fails, patients are offered bladder removal surgery (radical cystectomy (RC)), a major surgical intervention with impact on quality of life. This study quantifies the trade-offs patients are willing to make when choosing between RC and an alternative medical treatment.

METHODS: An online discrete choice experiment was completed by adults in the UK, France, Germany and Canada who were, or had been, treated with BCG therapy, or have undergone RC for NMIBC. Participants repeatedly chose between immediate RC and two hypothetical medical treatments that varied in: time-to-RC; risk of progressing to MIBC (muscle invasive bladder cancer) while on treatment; risk of serious side effects (SAEs); and administration. Preferences were analysed with an error-component logit model. Relative attribute importance (RAI) scores and minimum acceptable time to RC were obtained to explore patients’ treatment priorities.

RESULTS: The study included 107 patients (64% male, average age 63 years, 93% diagnosed with NMIBC 1-5 years before; 82% Eastern Cooperative Oncology Group performance status ≤2). Delay in time to RC had the largest influence on treatment preferences (RAI = 55.0%), followed by reducing the risk of progressing to MIBC while on treatment (RAI = 25.1%), and less frequent administrations (RAI 11.6%). Risk of SAEs (RAI = 8.3%) was the least important attribute. Patients were willing to accept a 20% increase in the risk of progressing to MIBC for an additional 2.3-years until RC, and a 10% increase in the risk of SAEs for an additional 0.8-years until RC.

CONCLUSIONS: Patients treated with BCG for NMIBC placed a high importance on delaying RC and were willing to accept increased risks of both SAEs and progression to MIBC for prolonged bladder preservation.