A Cost-effectiveness Analysis of Management of Low-risk Non–muscle-invasive Bladder Cancer Using Office-based Fulguration

ObjectiveTo examine the cost-effectiveness of endoscopic treatment of low-risk non–muscle-invasive bladder cancer (NMIBC) via office-based fulguration vs operating room–based transurethral resection of the bladder (TURB).MethodsA Markov state-transition model was created to simulate and compare the economic burden of managing patients with office-based fulguration vs TURB. Direct procedural and hospitalization costs were queried from our institution. Patients were modeled as being followed up routinely with flexible cystoscopy, whereas tumor recurrences were treated with either fulguration or TURB.ResultsA strategy of office-based fulguration was more cost-effective than TURB ($1171 per quality-adjusted life year [QALY] vs $1208 per QALY) to treat recurrent NMIBC over a 5-year period. Fulguration was both more effective (14.94 vs 14.91 QALYs) as well as less expensive ($17,494 vs $18,005), thus dominating TURB. The incremental cost-effectiveness ratio was −$18,440 per QALY. Sensitivity analysis demonstrates that the relative costs of the procedures are more significant in determining cost-effectiveness than their respective utilities.ConclusionOffice-based cystoscopy and fulguration was more cost-effective than TURB for treating recurrent low-risk NMIBC. Adherence to an office-based treatment plan can lead to significant cost savings with a decreased therapeutic burden over the lifetime of a patient with NMIBC.