A cost consequence analysis for utilising intermittent ADXBLADDER testing in the follow up of patients with non-muscle invasive bladder cancer, compared to standard care

Introduction: Non-muscle invasive bladder cancer is one of the most expensive cancers to manage, with a high recurrence rate and high costs associated with surveillance. We present an economic analysis for introducing an ADXBLADDER-based surveillance strategy, performed in place of flexible cystoscopy at alternating visits, to elucidate cumulative associated costs compared to the current standard practice. Materials & Methods: Analysis included 1431 patients from a large prospective study previously carried out. A Markov model, utilizing 4 health states and 3 risk groups, was constructed to determine the average 5-year costs of 2 strategies: a conventional strategy (flexible cystoscopy at every follow-up visit) and an intervention (ADXBLADDER testing instead of cystoscopy at alternate follow-up visits). An NHS perspective was adopted in the analysis, in-line with NICE recommendations in the cost-consequence analysis (CCA), reporting average cost per patient and commissioning perspective in budget impact model reporting total costs of the 2 strategies. Results: The major driver of costs was disease progression, frequent cystoscopic surveillance, and costs associated with an undetected progression. There was no statistically significant difference in the probability of moving between disease states between the 2 surveillance strategies. Performance characteristics for ADXBLADDER compared to flexible cystoscopy improved with NMIBC disease severity. The cumulative costs of care differed significantly dependent on NMIBC risk. Conclusion: Differential healthcare costs of the 2 strategies were demonstrated. The data from the modelling supports a strategy which could enable an improvement in quality of care and economic outcomes for NMIBC, including cost-savings by reducing unnecessary procedures.