Effects of Bladder Cancer on UK Healthcare Costs and Patient Health-Related Quality of Life: Evidence From the BOXIT Trial

Limited evidence exists regarding the costs and health-related quality of life (HRQoL) effects of bladder cancer. Our study derived both the mean and marginal UK HRQoL and cost effects across multiple grades and stages of bladder cancer using data from the BOXIT (bladder COX-2 inhibition trial; n = 472). We found that patients with bladder cancer will experience decrements in HRQoL, which impose significant costs in the event of disease recurrence or progression that increase with the abnormality and invasiveness of the lesion. The results of the present study will help to lay the foundation for future burden of disease studies and cost-effectiveness analyses. Background: Limited evidence exists regarding the cost and health-related quality of life (HRQoL) effects of non -muscle-invasive bladder cancer (NMIBC) recurrence and progression to muscle-invasive bladder cancer (MIBC). We examined these effects using evidence from a recent randomized control trial. Material and Methods: The costs and HRQoL associated with bladder cancer were assessed using data from the BOXIT trial (bladder COX-2 inhibition trial; n - 472). The cost and HRQoL effects from clinical events were estimated using generalized estimating equations. The costs were derived from the recorded resource usage and UK unit costs. HRQoL was assessed using the EQ-5D-3L and reported UK preference tariffs. The events were categorized using the TMN classification. Results: Cases of grade 3 recurrence and progression were associated with statistically significant HRQoL decrements ( 0.08; 95% confidence interval [CI], 0.13 to 0.03; and 0.10; 95% CI, 0.17 to 0.03, respectively). The 3-year average cost per NMIBC patient was estimated at 8735 pound (95% CI, 8325-9145). Cases of grade 1, 2, and 3 recurrence were associated with annual cost effects of 1218 pound (95% CI, 403-2033), 1677 pound (95% CI, 920-2433), and 3957 pound (95% CI, 2332-5583), respectively. Progression to MIBC was associated with an average increase in costs of 5407 pound (95% CI, 2663-8152). Conclusion: Evidence from the BOXIT trial suggests that patients with NMIBC will both experience decrements in HRQoL and incur significant costs, especially in the event of a grade 3 recurrence or a progression to MIBC. (C) 2019 The Author(s). Published by Elsevier Inc.