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ORIGINAL RESEARCH article
Front. Oncol.
Sec. Molecular and Cellular Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1556881
Cost-effectiveness of de-escalated molecular subtype dependent use of neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer in a Swedish setting
Provisionally accepted
Sanjib Saha 1*
Ulf-Göran Gerdtham 1
Gottfrid Sjödahl 1
Christel Häggström 2 James W F Catto 3 John D Kelly 4 Anders Ullén 5 Lars Holmberg 2 Fredrik Liedberg 1- 1 Lund University Library, Lund University, Lund, Sweden
- 2 Uppsala University, Uppsala, Uppsala, Sweden
- 3 The University of Sheffield, Sheffield, England, United Kingdom
- 4 University College London, London, England, United Kingdom
- 5 Karolinska Institutet (KI), Solna, Stockholm, Sweden
Background: Guidelines recommend neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC). Current recommendations do not consider genomic profiles, although the Basal/Squamous (Ba/Sq) subtype is less likely to respond to NAC compared to Urothelial-like (Uro) and Genomically Unstable (GU) subtypes. The aim of this study is to perform cost-effectiveness analyses of a de-escalated use of NAC in patients with Ba/Sq tumors and MIBC.Methods: A cost-effectiveness analysis was performed using a decision analytic Markov model using a healthcare provider perspective. Treatment and prognosis probabilities originated from the Bladder Cancer Data Base, Sweden (BladderBaSe) 2.0. Information on molecular subtype and outcomes was retrieved from published studies, and quality-adjusted life year (QALY) data were obtained from the iROC trial. Costs were collected from the regional healthcare registers in Sweden, utility values were obtained from the literature, and outcomes are presented as incremental cost-effectiveness ratio (ICER). Scenario analyses, along with several one-way and probabilistic sensitivity analyses were performed to capture uncertainties.Results: At a 5-year time horizon, the model predicts that molecular subtype-based treatment has an ICER of 4,964 Euro/QALY (66,766 Swedish Krona /QALY), which is deemed cost-effective in the Swedish setting. At €7,427 (100,000 SEK) willingness-to-pay threshold, the molecular subtype-based treatment has a 65% probability of being cost-effective. The results were not sensitive to uncertainty analyses.Molecular subtype-based treatment of MIBC, i.e., refraining from administering NAC to patients with Ba/Sq tumors, is cost-effective compared to the current treatment practices in Sweden.
Keywords: cost-effectiveness analysis, muscle invasive bladder cancer, Molecular subtype, Neoadjuvant chemotherapy, Radical cystectomy
Received: 07 Jan 2025; Accepted: 07 Mar 2025.
Copyright: © 2025 Saha, Gerdtham, Sjödahl, Häggström, Catto, Kelly, Ullén, Holmberg and Liedberg. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Sanjib Saha, Lund University Library, Lund University, Lund, Sweden
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