|
The Journal
of Urology Vol. 163, 752-757, March 2000.
COMPARISON
OF MOLECULAR AND CONVENTIONAL STRATEGIES
FOR
FOLLOWUP OF SUPERFICIAL BLADDER CANCER USING
DECISION
ANALYSIS
ROBERT
K. NAM, DONALD A. REDELMEIER, PHILIPPE E. SPIESS,
HEATHER
A. SAMPSON, YVES FRADAT* AND
MAICHAEL A. S. JEWETT
From
the Division of Urology, Princess Margaret Hospital, University Health
Network, Department of Medicine, Sunnybrook and Women’s College Health
Sciences Centre, University of Toronto, Toronto, Ontario, and Division of
Urology, Laval University, Laval, Quebec, Canada
ABSTRACT
Purpose:
Patients with superficial bladder cancer require long-term surveillance
for recurrence. We compared the cost of cystoscopy and cytology (standard
care) to that of urinary markers (modified care) for patients with a
history of superficial bladder cancer.
Materials and Methods: We constructed a decision analysis model that
compared the 2 strategies for a hypothetical followup interval of 3 years.
Probabilities required for the decision tree were based on
a cohort of 361 patients diagnosed with superficial bladder cancer from
1987 to 1997. Sensitivity analyses were used to determine whether
sensitivity and specificity would affect cost thresholds. Costs for each
strategy were then applied to actual practice patterns.
Results: The cost of modified care ranged from $158 to $228 for each
followup visit when using a urinary marker with a sensitivity and
specificity of 95% and 77%, respectively. The cost of standard care was
$240 for each followup visit. Based on sensitivity analyses the
probability of disease recurrence and urinary marker accuracy were
important determinants of expected costs. Mean number of followup
assessments for patients followed more than 3 years was 4.3, 2.2, and 1.5
for years 1, 2, and 3, respectively. Cumulative costs of modified care
were lower than those of standard care.
Conclusions: Urinary marker testing for followup of patients with
superficial bladder cancer is less expensive than the standard method of
cystoscopy and urinary cytology based on our model. Future studies will be
required to consider other factors that could affect the cost advantage of
urinary markers, including indirect costs, the psychosocial impact of
testing and different surveillance frequencies.
KEY WORDS: bladder neoplasms; tumor markers, biological; decision
support techniques; costs and cost analysis
Accepted for publication October 15, 1999.
Supported by a grant from Diagnocure, Inc., Sainte-Foy, Quebec, and the
Surgical Scientist Program, Department of Surgery, University of Toronto,
Canada.
* Financial interest and/or other relationship with Diagnocure, Inc.
|
REFERENCES