Long-Term Outcomes and Costs of BCG Therapy for High-Risk Non–Muscle-Invasive Bladder Cancer
Posted: Tuesday, April 27, 2021
Management of high-risk non–muscle-invasive bladder cancer has posed a clinical challenge due to the high treatment failure rates. Stephen B. Williams, MD, MS, of The University of Texas Medical Branch, Galveston, and colleagues sought to examine the oncologic outcomes and attributable costs associated with Bacillus Calmette-Guérin (BCG) therapy in this patient population. The results of this retrospective cohort study, which were published in JAMA Network Open, revealed that disease progression might be associated with significantly increased costs of care.
“Studies like this are incredibly important in allowing physicians to understand the effectiveness of a specific treatment and downstream costs,” Dr. Williams commented in an institutional press release. “[This study] also underscores the need for additional therapies to reduce the risk of disease progression and further improve outcomes.”
The investigators focused on 412 patients who received at least one dose of BCG therapy at a Department of Veterans Affairs center between January 1, 2000, and December 31, 2015. Adequate induction BCG therapy was defined as at least five installations, and adequate maintenance BCG therapy was defined as at least seven installations.
In this patient population, 95% received adequate induction BCG therapy, and 37% received adequate maintenance BCG therapy. The 10-year progression-free survival and disease-specific death rates were 78% and 92%, respectively, in all patients. Patients with carcinoma in situ seemed to have worse disease-free survival outcomes than those without (hazard ratio = 1.85). The total median costs were $29,459, $55,267, and $117,361 at 1, 2, and 5 years, respectively. The median 5-year costs appeared to be significantly higher for patients with progressive disease than those without ($232,729 vs. $94,879; P < .001); outpatient care, pharmacy, and surgery-related costs seemed to be contributing factors.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.