TY  - JOUR
A1  - Lotan, Yair
A1  - Gakis, Georgios
A1  - Manfredi, Matteo
A1  - Morote, Juan
A1  - Mostafid, Hugh
A1  - Porpiglia, Francesco
A1  - Poyet, Cedric
A1  - Roupret, Morgan
A1  - Schulman, Claude
A1  - Shariat, Shahrokh F.
A1  - Witjes, Johannes Alfred
T1  - Alternating Cystoscopy with Bladder EpiCheck® in the Surveillance of Low-Grade Intermediate-Risk NMIBC: A Cost Comparison Model
JF  - Bladder Cancer
N2  - Background:
Bladder cancer surveillance is invasive, intensive and costly. Patients with low grade intermediate risk non-muscle invasive bladder cancer (NMIBC) are at high risk of recurrence.

Objective:
The objective of this model is to compare the cost of a strategy to alternate surveillance with cystoscopy and a urine marker, Bladder EpiCheck, to standard surveillance.

Methods:
A decision tree model was built using TreeAge Pro Healthcare to compare standard surveillance (Standard) with a modified surveillance incorporating Bladder EpiCheck. The model was based on 2 years of surveillance. Outcomes were obtained from literature. Costs were obtained from US and 9 European countries. Sensitivity analyses were performed.

Results:
The efficacy of the model was equivalent in terms of recurrence for each arm with median recurrence rate of 22%. When setting marker price at 200 local currency, the marker arm was less expensive in the USA, Netherlands, Switzerland, Belgium, Italy, Austria and UK by 154€ to 329£ per patient, for a 2-year period. Cost was higher in France, Spain, and Germany by 33–103€. Cost parity was achieved with marker price between 148€ and $421. Marker cost and specificity have the greatest impact on the overall model cost.

Conclusions:
A strategy alternating the urine marker Bladder EpiCheck with cystoscopy in the surveillance of patients with low grade intermediate risk bladder cancer is cost equivalent in the US and European countries when the marker is priced 148€ –$421, as a result of the marker’s high specificity (86%). Prospective studies will be necessary to validate these findings.
KW  - bladder cancer
KW  - urinary markers
KW  - NMIBC surveillance
KW  - cost model
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-369512
VL  - 7
ER  - 
TY  - JOUR
A1  - D'Andrea, David
A1  - Soria, Francesco
A1  - Grotenhuis, Anne J.
A1  - Cha, Eugene K.
A1  - Malats, Nuria
A1  - Di Stasi, Savino
A1  - Joniau, Steven
A1  - Cai, Tommaso
A1  - Rhijn, Bas W. G. van
A1  - Irani, Jaques
A1  - Karnes, Jeffrey
A1  - Varkarakis, John
A1  - Baniel, Jack
A1  - Palou, Joan
A1  - Babjuk, Marek
A1  - Spahn, Martin
A1  - Ardelt, Peter
A1  - Colombo, Renzo
A1  - Serretta, Vincenzo
A1  - Dalbagni, Guido
A1  - Gontero, Paolo
A1  - Bartoletti, Riccardo
A1  - Larré, Stephane
A1  - Malmstrom, Per-Uno
A1  - Sylvester, Richard
A1  - Shariat, Shahrokh F.
T1  - Association of patients’ sex with treatment outcomes after intravesical bacillus Calmette–Guérin immunotherapy for T1G3/HG bladder cancer
JF  - World Journal of Urology
N2  - Purpose
To investigate the association of patients’ sex with recurrence and disease progression in patients treated with intravesical bacillus Calmette–Guérin (BCG) for T1G3/HG urinary bladder cancer (UBC).

Materials and methods
We analyzed the data of 2635 patients treated with adjuvant intravesical BCG for T1 UBC between 1984 and 2019. We accounted for missing data using multiple imputations and adjusted for covariate imbalance between males and females using inverse probability weighting (IPW). Crude and IPW-adjusted Cox regression analyses were used to estimate the hazard ratios (HR) with their 95% confidence intervals (CI) for the association of patients’ sex with HG-recurrence and disease progression.

Results
A total of 2170 (82%) males and 465 (18%) females were available for analysis. Overall, 1090 (50%) males and 244 (52%) females experienced recurrence, and 391 (18%) males and 104 (22%) females experienced disease progression. On IPW-adjusted Cox regression analyses, female sex was associated with disease progression (HR 1.25, 95%CI 1.01–1.56, p = 0.04) but not with recurrence (HR 1.06, 95%CI 0.92–1.22, p = 0.41). A total of 1056 patients were treated with adequate BCG. In these patients, on IPW-adjusted Cox regression analyses, patients’ sex was not associated with recurrence (HR 0.99, 95%CI 0.80–1.24, p = 0.96), HG-recurrence (HR 1.00, 95%CI 0.78–1.29, p = 0.99) or disease progression (HR 1.12, 95%CI 0.78–1.60, p = 0.55).

Conclusion
Our analysis generates the hypothesis of a differential response to BCG between males and females if not adequately treated. Further studies should focus on sex-based differences in innate and adaptive immune system and their association with BCG response.
KW  - bladder cancer
KW  - BCG
KW  - response
KW  - age
KW  - progression
KW  - recurrence
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-344486
VL  - 39
IS  - 9
ER  -