An economic analysis comparing health care resource use and cost of dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin versus gemcitabine and cisplatin as neoadjuvant therapy for muscle invasive bladder cancer

• Published in: Urologic oncology Vol. 39; no. 12; pp. 834.e1 - 834.e7
• Main Authors: Montazeri, K., Dranitsaris, G., Thomas, JD, Curran, C., Preston, MA, Steele, GS, Kilbridge, KL, Mantia, C., Ravi, P., McGregor, BA, Mossanen, M., Sonpavde, G.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2021
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - pharmacology; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Chemotherapy; Cisplatin; Cisplatin - pharmacology; Cisplatin - therapeutic use; Cost-effectiveness; Delivery of Health Care - economics; Deoxycytidine - analogs & derivatives; Deoxycytidine - pharmacology; Deoxycytidine - therapeutic use; Dose-dense (dd)MVAC; Doxorubicin - pharmacology; Doxorubicin - therapeutic use; Female; Gemcitabine; Humans; Male; Methotrexate - pharmacology; Methotrexate - therapeutic use; Middle Aged; Muscle-invasive bladder cancer; Neoadjuvant; Neoadjuvant Therapy - methods; Prospective Studies; Resource utilization; Retrospective Studies; Urinary Bladder Neoplasms - drug therapy; Urinary Bladder Neoplasms - economics; Vinblastine - pharmacology; Vinblastine - therapeutic use; Chemotherapy; Resource utilization; Muscle-invasive bladder cancer; Gemcitabine; Dose-dense (dd)MVAC; Neoadjuvant; Cost-effectiveness; Cisplatin
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2021.04.032

•Dose-dense methotrexate, vinblastine, doxorubicin, cisplatin ddMVAC and gemcitabine cisplatin (GC) exhibited differences in health resource utilization (HRU).•GC exhibited 41% lower costs compared to ddMVAC.•The median adjusted cost savings with GC was $7,410 per patient.•The study is limited by the single-center retrospective design.•Prospective studies should incorporate HRU and cost efficacy assessments.
To compare healthcare resource utilization (HRU) and costs associated with dose-dense methotrexate, vinblastine, doxorubicin, cisplatin (ddMVAC) and gemcitabine, cisplatin (GC) as neoadjuvant chemotherapy for muscle-invasive bladder cancer (MIBC).
Patient treated at Dana-Farber Cancer Institute from 2010 to 2019 were identified. HRU data on chemotherapy administered, supportive medications, patient monitoring, clinic, infusion, emergency department (ED) visits and hospitalization were collected retrospectively. Unit costs for HRU components were obtained from the Centers for Medicare and Medicaid Website and HRU was compared between groups using quantile regression analysis.
137 patients were included; 51 received ddMVAC and 86 GC. Baseline characteristics were similar, except lower mean age (P < 0.001) and higher proportion of ECOG-PS = 0 (P < 0.001) for ddMVAC. ddMVAC required more granulocyte-colony stimulating factor support (P < 0.001), central line placement (P = 0.017), cardiac imaging (P < 0.001), and infusion visits (P < 0.001), whereas GC required more clinic visits. ED visits were higher for ddMVAC (P = 0.048), while chemotherapy cycle delays and hospitalization days were higher for GC (P = 0.008). After adjusting for ECOG-PS and age, the cost per patient was approximately 41% lower (95%CI: 28% to 52%; P < 0.001) for GC vs. ddMVAC, which translated to a median adjusted cost savings of $7,410 (95%CI: $5,474-$9,347) per patient.
Although excess HRU did not clearly favor one regimen, adjusting for PS and age indicated lower costs with GC vs. ddMVAC. Given the similar cumulative cisplatin delivery with both regimens, the associated values and costs supports the preferential selection of GC in the neoadjuvant setting of MIBC.