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

Abstract

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 (95% CI, 8325-9145). Cases of grade 1, 2, and 3 recurrence were associated with annual cost effects of £1218 (95% CI, 403-2033), £1677 (95% CI, 920-2433), and £3957 (95% CI, 2332-5583), respectively. Progression to MIBC was associated with an average increase in costs of £5407 (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.

Keywords: Cost; HRQoL; NMIBC; QALY; RCT.

Figure 1

EQ-5D Scores for High-risk Patients for Each Event-related Subgroup and Associated Proportion of Events in Each Follow-up Point During 3 Years of Follow-up. The x-Axis Represents Time in Months After Baseline With Categories and Their Distance Solely Indicative of Trial Follow-up and Not Equating to the Length of Time Between Intervals

Figure 2

Mean Costs per Patient Over Time Stratified by Resource Category for Intermediate- and High-risk Patients

Figure 3

Estimated Mean Change in Annual Cost per Patient Associated With Clinical Events (95% Confidence Intervals Shown by Vertical Bars) From a Multivariate Longitudinal Panel Cost-related Analysis Controlling for Treatment, Patient Characteristics, Risk Group, Annual Time Dummies, Bladder Cancer Events, and Interactions

Supplemental Figure 1

EQ-5D Responses Stratified by Dimension and Severity Level for High-risk Patients for Each Event-related Subgroup During 3 Years of Follow-up. The Number Indicates the Maximum Number of Observations Recorded of an EQ-5D Dimension for a Given Event-related Subgroup (eg, ≤ 119 Recordings Were Made of an EQ-5D Dimension for Patients Who Had Experienced a Grade 2 Recurrence During the 3-year Follow-up Period)