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Review
. 2020 Nov 23:12:693-709.
doi: 10.2147/CEOR.S274951. eCollection 2020.

Humanistic and Economic Burden of Non-Muscle Invasive Bladder Cancer: Results of Two Systematic Literature Reviews

Lauren J Lee  1 , Christina S Kwon  2 , Anna Forsythe  2 , Carla M Mamolo  3 , Elizabeth T Masters  1 , Ira A Jacobs  4
Affiliations
Review

Humanistic and Economic Burden of Non-Muscle Invasive Bladder Cancer: Results of Two Systematic Literature Reviews

Lauren J Lee et al. Clinicoecon Outcomes Res. .

Abstract

Purpose: Non-muscle invasive bladder cancer (NMIBC) is a malignancy restricted to the inner lining of the bladder. Intravesical Bacillus Calmette-Guerin (BCG) following transurethral resection of the bladder tumor is the mainstay first-line treatment for high-risk NMIBC patients. Two systematic literature reviews (SLRs) were conducted to further assess the current evidence on BCG use in NMIBC and the humanistic and economic burden of disease.

Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, Embase® and MEDLINE® were searched using the Ovid platform to identify interventional or real-world evidence studies on the health-related quality of life (HRQoL) and economic burden in NMIBC. Limited evidence was found from initial economic SLR searches in NMIBC, so additional targeted searches for bladder cancer were conducted to expand findings.

Results: Fifty-nine publications were included in the HRQoL SLR, of which 23 reported HRQoL and symptoms in NMIBC. At diagnosis, HRQoL was comparable with population norms but worsened considerably 2 years following diagnosis. Maintenance therapy with intravesical BCG was associated with reduced HRQoL, and treatment-related adverse events (AEs) resembled typical NMIBC symptoms. Twenty-two studies reported decreasing BCG compliance over time. Common AEs with BCG were frequent urination, lower urinary tract symptoms, pain, and hematuria. Forty-two publications were included in the economic SLR, of which nine assessed healthcare costs and resource use in NMIBC or bladder cancer. High-risk disease and high-intensity treatment were associated with increased healthcare costs.

Conclusion: NMIBC has a considerable symptomatic, HRQoL, and economic burden. Symptoms persisted and HRQoL worsened despite intravesical BCG treatment. NMIBC is a costly disease, with higher healthcare costs associated with increased risk of disease progression and recurrence. There is a high unmet need for safe and effective treatments that reduce the risk of disease progression and recurrence, provide symptomatic relief, and improve HRQoL for patients.

Keywords: NMIBC; costs; health-related quality of life; symptoms.

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Conflict of interest statement

Ira A Jacobs, Lauren J Lee, Carla M Mamolo, and Elizabeth T Masters are employees of Pfizer Inc. and own Pfizer stock. Christina S Kwon and Anna Forsythe are employees of Purple Squirrel Economics who were paid consultants to Pfizer in connection with the development of this manuscript. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
PRISMA flow diagrams for the HRQoL and economic SLRs (A and B).
Figure 2
Figure 2
HRQoL studies by NMIBC treatment and study type.
Figure 3
Figure 3
Decline in NMIBC HRQoL 2 years post-diagnosis on the SF-36* versus the general population**.
Figure 4
Figure 4
EORTC QLQ-C30 during BCG treatment.*#.
Figure 5
Figure 5
EORTC QLQ-NMIBC24 during BCG treatment.*.
See this image and copyright information in PMC

References

    1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. doi:10.3322/caac.21492 - DOI - PubMed
    1. National Cancer Institute. Cancer of the urinary bladder - cancer stat facts. SEER. Available at: https://seer.cancer.gov/statfacts/html/urinb.html.
    1. American Cancer Society. Key statistics for bladder cancer. Available at: https://www.cancer.org/cancer/bladder-cancer/about/key-statistics.html.
    1. Martin JW, Carballido EM, Ahmed A, et al. Squamous cell carcinoma of the urinary bladder: systematic review of clinical characteristics and therapeutic approaches. Arab J Urol. 2016;14(3):183–191. doi:10.1016/j.aju.2016.07.001 - DOI - PMC - PubMed
    1. NCCN. NCCN clinical practice guidelines in oncology. Bladder Cancer. NCCN Evidence BlocksTM version 6. 2020. July 22, 2020:1–121.

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