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Cost-effectiveness of de-escalated molecular subtype dependent use of neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer in a Swedish setting

Year: 2025
Type: article
Abstract: Background: Guidelines recommend neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC). Current recommendations do not consider genomic profiles, although the Basal/Squamous (Ba/Sq) subtype is less likely to respond to NAC compared to Urothelial-like (Uro) and Genomically Unstable (GU) subtypes. The aim of this study is to perform cost-effectiveness analyses of a de-escalated use of NAC in patients with Ba/Sq tumors and MIBC. Methods: A cost-effectiveness analysis was performed using a decision analytic Markov model using a healthcare provider perspective. Treatment and prognosis probabilities originated from the Bladder Cancer Data Base, Sweden (BladderBaSe) 2.0. Information on molecular subtype and outcomes was retrieved from published studies, and quality-adjusted life year (QALY) data were obtained from the iROC trial. Costs were collected from the regional healthcare registers in Sweden, utility values were obtained from the literature, and outcomes are presented as incremental cost-effectiveness ratio (ICER). Scenario analyses, along with several one-way and probabilistic sensitivity analyses were performed to capture uncertainties. Results: At a 5-year time horizon, the model predicts that molecular subtype-based treatment has an ICER of 4,964 Euro/QALY (66,766 Swedish Krona/QALY), which is deemed cost-effective in the Swedish setting. At €7,427 (100,000 SEK) willingness-to-pay threshold, the molecular subtype-based treatment has a 65% probability of being cost-effective. The results were not sensitive to uncertainty analyses. Conclusion: Molecular subtype-based treatment of MIBC, i.e., refraining from administering NAC to patients with Ba/Sq tumors, is cost-effective compared to the current treatment practices in Sweden.
DOI: 10.3389/fonc.2025.1556881
Authors: Sanjib Saha, Ulf-Göran Gerdtham, Gottfrid Sjödahl, Christel Häggström, James W. F. Catto, John D. Kelly, Anders Ullén, Lars Holmberg, Fredrik Liedberg
Institutions: Lund University, Skåne University Hospital, Uppsala University, Umeå University, University of Sheffield, University College London, Karolinska University Hospital, Karolinska Institutet, King's College London
Language: English
Subfield: Surgery
Field: Medicine
Open Access status: gold
Estimated APC paid: $3,801
Funders: Skåne County Council's Research and Development Foundation, Cancerfonden, Fondation pour la Recherche Médicale, Vetenskapsrådet, Forskningsrådet om Hälsa, Arbetsliv och Välfärd, Skånes universitetssjukhus
Awards: G1257087082, G2102436694, G3356829005, Translation of bladder cancer molecular subtypes into clinical practice to personalize treatment decisions from non-muscle invasive to metastatic disease, G4570019957, G587442591, Preventing inequalities in health through better policy decisions of preventative and health promoting interventions
OpenAlex ID: W4409083778
FWCI:
Cites: 40
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Related to: 10