Photodynamic Diagnosis-guided Transurethral Resection of Bladder Tumour in Participants with a First Suspected Diagnosis of Intermediate- or High-risk Non-muscle-invasive Bladder Cancer: Cost-effectiveness Analysis Alongside a Randomised Controlled Trial.
Ge Yu, Stephen Rice, Rakesh Heer, Rebecca Lewis, Thenmalar Vadiveloo, Paramananthan Mariappan, Steven Penegar, Emma Clark, Zafer Tandogdu, Emma Hall, Luke Vale
Author Information
Ge Yu: Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
Stephen Rice: Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
Rakesh Heer: Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK.
Rebecca Lewis: The Institute of Cancer Research, London, UK.
Thenmalar Vadiveloo: Centre for Healthcare Randomized Trials, University of Aberdeen, Aberdeen, UK.
Paramananthan Mariappan: Edinburgh Bladder Cancer Surgery, Department of Urology, Western General Hospital, Edinburgh, UK.
Steven Penegar: The Institute of Cancer Research, London, UK.
Emma Clark: Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK.
Zafer Tandogdu: University College London Hospitals NHS Foundation Trust, London, UK.
Emma Hall: The Institute of Cancer Research, London, UK.
Luke Vale: Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
Background: Recurrence of non-muscle-invasive bladder cancer (NMIBC) is common after transurethral resection of bladder tumour (TURBT). Photodynamic diagnosis (PDD) may reduce recurrence. PDD uses a photosensitiser in the bladder that causes the tumour to fluoresce to guide resection. PDD provides better diagnostic accuracy and allows more complete tumour resection. Objective: To estimate the economic efficiency of PDD-guided TURBT (PDD-TURBT) in comparison to white light-guided TURNT (WL-TURBT) in individuals with a suspected first diagnosis of NMIBC at intermediate or high risk of recurrence on the basis of routine visual assessment before being scheduled for TURBT. Design setting and participants: This is a health economic evaluation alongside a pragmatic, open-label, parallel-group randomised trial from a societal perspective. A total of 493 participants (aged ���16 yr) were randomly allocated to PDD-TURBT ( = 244) or WL-TURBT ( = 249) in 22 UK National Health Service hospitals. Outcome measurements and statistical analysis: Cost effectiveness ratios were based on the use of health care resources associated with PDD-TURBT and WL-TURBT and quality-adjusted life years (QALYs) gained within the trial. Uncertainties in key parameters were assessed using sensitivity analyses. Results and limitations: On the basis of the use of resources driven by the trial protocol, the incremental cost effectiveness of PDD-TURBT in comparison to WL-TURBT was not cost saving. At 3 yr, the total cost was ��12 881 for PDD-TURBT and ��12 005 for WL-TURBT. QALYs at three years were 2.087 for PDD-TURBT and 2.094 for WL-TURBT. The probability that PDD-TURBT is cost effective was never >30% above the range of societal cost-effectiveness thresholds. Conclusions: There was no evidence of a difference in either costs or QALYs over 3-yr follow-up between PDD-TURBT and WL-TURBT in individuals with suspected intermediate- or high-risk NMIBC. PDD-TURBT is not supported for the management of primary intermediate- or high-risk NMIBC. Patient summary: We assessed overall costs for two approaches for removal of bladder tumours in noninvasive cancer and measured quality-adjusted life years gained for each. We found that use of a photosensitiser in the bladder was not more cost effective than use of white light only during tumour removal.
