Cost-effectiveness analysis of transurethral resection of bladder tumor with photodynamic diagnosis with 5-aminolevulinic acid hydrochloride for non-muscle invasive bladder cancer.

OBJECTIVE

Photodynamic diagnosis (PDD)-assisted transurethral resection of bladder tumor (TURBT) is effective for preventing recurrence in patients with non-muscle invasive bladder cancer (NMIBC). However, the cost of PDD-TURBT is higher than that of standard white-light TURBT (WL-TURBT), given the use of photodynamic devices and 5-aminolevulinic acid hydrochloride (ALA). Accordingly, we evaluated the cost-effectiveness of PDD-TURBT with ALA.

METHODS

This retrospective cohort study included patients with NMIBC who underwent TURBT at Kochi University Hospital (2010‒2021), categorized by their initial TURBT into the PDD-TURBT and WL-TURBT groups. We evaluated cost-effectiveness and quality-adjusted life years (QALYs) using survival analysis with a multistate model, which defined six health states: disease-free, first recurrence, second recurrence, three or more recurrences, total bladder removal, and death. Quality of life (QOL) values for each state were adopted from previous studies.

RESULTS

Overall, 303 patients were analyzed (PDD-TURBT, n = 111; WL-TURBT, n = 192). The mean age was 73.3 years, and 232 (76.6%) were male. Adjusted 3-year disease-free survival rates were 0.60 and 0.40 in the PDD-TURBT and WL-TURBT groups, respectively. The incremental cost-effectiveness ratio (ICER) for PDD-TURBT was ¥309,812 per 1-year of disease-free time and ¥802,192 per 1-life year. Assuming a QOL of 0.87, the ICER was ¥922,060 (£5,123) per QALY, below the recommended threshold of "£20,000 to £30,000/QALY" suggested by the National Institute for Health and Care Excellence (NICE).

CONCLUSIONS

Our analysis demonstrated that the cost of PDD-TURBT is lower than the NICE-recommended £20,000-£30,000/QALY and is cost-effective compared with WL-TURBT.