To Assess the Cost-Effectiveness of Innovative Monitoring Strategies in Bladder Cancer : The Choice of a Discrete Event Simulation Modelling.
Author(s)
ABSTRACT WITHDRAWN
The follow-up of patients with treated bladder cancer degrades their quality of life and is one of the most expensive. Indeed, actual standard of care is a surveillance based on iterative cystoscopies. Urinary markers held the potential to lower this burden, yet without replacing the current strategy. A recent RT-PCR test could address this issue thanks to better diagnosis performance. A cost-effectiveness evaluation of different surveillance pathways and rhythms needs to be undertaken. As there is no randomized controlled trial evidence to support these new schedules, a model-based analysis is required. The objective was to find the best type of model. First, a review of the literature was performed in order to identify the type of models that have been previously used in bladder cancer surveillance. Five studies have finally been retained: three trees and two Markov models. However, these studies presented still many limitations, for instance by reposing on hypothetical scenarios that were not validated. Then, the natural history of the surveillance of bladder tumors has been described. The main properties were that (i) the disease and its care are complex; (ii) an individual-centered approach is necessary; (iii) patients meet competing risks and (iv) the time needs to be taken into account in a continuously manner. The choice of the gold-standard model was made following methodogically the ISPOR guidelines. A discrete event simulation (DES) model is chosen. It is interesting to note that DESs have been used in some surveillance of other malignancies. However, this is the first time that a DES will be used to model different strategies in order to optimize the surveillance of bladder cancer within a cost-effectiveness evaluation. This will allow to find the best rhythm between invasive cystoscopies and non-invasive urinary markers.
Conference/Value in Health Info
2020-11, ISPOR Europe 2020, Milan, Italy
Value in Health, Volume 23, Issue S2 (December 2020)
Code
PUK7
Topic
Medical Technologies, Methodological & Statistical Research
Topic Subcategory
Diagnostics & Imaging
Disease
Medical Devices, Oncology, Urinary/Kidney Disorders