Cost‐effectiveness of surveillance schedules in older adults with non‐muscle‐invasive bladder cancer

OBJECTIVE: To estimate the cost‐effectiveness of surveillance schedules for non‐muscle‐invasive bladder cancer (NMIBC) amongst older adults. PATIENTS AND METHODS: We developed a MIcrosimulation SCreening ANalysis (MISCAN) microsimulation model to compare the cost‐effectiveness of various surveillance schedules (every 3 months to every 24 months, for 2, 5 or 10 years or lifetime) for older adults (aged 65–85 years) with NMIBC. For each surveillance schedule we calculated total costs per patient and the number of quality adjusted life‐years (QALYs) gained. Incremental cost‐effectiveness ratios (ICERs), as incremental costs per QALY gained, were calculated using a 3% discount. RESULTS: As age increased, the number of QALYs gained per patient decreased substantially. Surveillance of patients aged 65 years resulted in 2–7 QALYs gained, whereas surveillance at age 85 years led to <1 QALY gained. The total costs of the surveillance schedules also decreased as age increased. The ICER of 6‐monthly surveillance at age 65 years for lifetime was $4999 (American dollars)/QALY gained. Amongst patients aged >75 years, the incremental yield of QALY gains for any increase in surveillance frequency and/or duration was quite modest (<2 QALYs gained). CONCLUSION: With increasing age, surveillance for recurrences leads to substantially fewer QALYs gained. These data support age‐specific surveillance recommendations for patients treated for NMIBC.