Cost-effectiveness of surveillance schedules in older adults with non-muscle-invasive bladder cancer

Objective To estimate the cost-effectiveness of surveillance schedules for non-muscle-invasive bladder cancer (NMIBC) amongst older adults. Patients and Methods We developed a MIcrosimulation SCreening ANalysis (MISCAN) microsimulation model to compare the cost-effectiveness of various surveillance schedules (every 3 months to every 24 months, for 2, 5 or 10 years or lifetime) for older adults (aged 65-85 years) with NMIBC. For each surveillance schedule we calculated total costs per patient and the number of quality adjusted life-years (QALYs) gained. Incremental cost-effectiveness ratios (ICERs), as incremental costs per QALY gained, were calculated using a 3% discount. Results As age increased, the number of QALYs gained per patient decreased substantially. Surveillance of patients aged 65 years resulted in 2-7 QALYs gained, whereas surveillance at age 85 years led to QALY gained. The total costs of the surveillance schedules also decreased as age increased. The ICER of 6-monthly surveillance at age 65 years for lifetime was $4999 (American dollars)/QALY gained. Amongst patients aged >75 years, the incremental yield of QALY gains for any increase in surveillance frequency and/or duration was quite modest (QALYs gained). Conclusion With increasing age, surveillance for recurrences leads to substantially fewer QALYs gained. These data support age-specific surveillance recommendations for patients treated for NMIBC.