TITLE: Treatments for Bladder Cancer: Clinical and Cost ...

[Pages:7]TITLE: Treatments for Bladder Cancer: Clinical and Cost-Effectiveness

DATE: 11 January 2017

RESEARCH QUESTIONS

1. What is the clinical effectiveness of bladder preservation treatment in patients with bladder cancer?

2. What is the cost-effectiveness of treatments for bladder cancer?

KEY FINDINGS

Three systematic reviews and meta-analyses, six non-randomized studies, and one economic evaluation were identified regarding the clinical and cost-effectiveness of treatments for bladder cancer.

METHODS

A limited literature search was conducted with main concepts appearing in title or major subject heading, on key resources including PubMed, The Cochrane Library, University of York Centre for Reviews and Dissemination (CRD) databases, Canadian and major international health technology agencies, as well as a focused Internet search. To address research question one, methodological filters were applied to limit retrieval to health technology assessments, systematic reviews, meta-analyses, randomized controlled trials, and non-randomized studies. To address research question two, methodological filters were applied to limit retrieval to economic studies. Where possible, retrieval was limited to the human population. The search was also limited to English language documents published between January 1, 2012 and December 19, 2016. Internet links were provided, where available.

The summary of findings was prepared from the abstracts of the relevant information. Please note that data contained in abstracts may not always be an accurate reflection of the data contained within the full article.

Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic review s. The intent is to provide a list of sources of the best evidence on the topic that the Canadian Agency for Drugs and Technologies in Health (CADTH) could identify using all reasonable efforts within the time allow ed. Rapid responses should be considered along w ith other ty pes of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for w hich little information can be found, but w hich may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that ef f ect. CADTH is not liable f or any loss or damages resulting f rom use of the inf ormation in the report.

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SELECTION CRITERIA

One reviewer screened citations and selected studies based on the inclusion criteria presented in Table 1.

Population Intervention

Comparator Outcomes Study Designs

Table 1: Selection Criteria Patients with bladder cancer Q1: Bladder preservation treatment Q2: Any treatment of bladder cancer (i.e., radical cystectomy, bladder preservation treatment, etc.) Q1: Not receiving bladder preservation treatment Q2: Another form of bladder cancer treatment Q1: Quality of life, safety, harm Q2: Cost-effectiveness Health technology assessments, systematic reviews, meta-analyses, randomized controlled trials, non-randomized studies, economic evaluations

RESULTS

Rapid Response reports are organized so that the higher quality evidence is presented first. Therefore, health technology assessment reports, systematic reviews, and meta-analyses are presented first. These are followed by randomized controlled trials, non-randomized studies, and economic evaluations.

Three systematic reviews and meta-analyses, six non-randomized studies, and one economic evaluation were identified regarding the clinical and cost-effectiveness of treatments for bladder cancer. No health technology assessments or randomized controlled trials were identified.

Additional references of potential interest are provided in the appendix.

OVERALL SUMMARY OF FINDINGS

Three systematic reviews and meta-analyses1-3 were identified regarding the clinical effectiveness of bladder preservation treatment in patients with bladder cancer. One systematic review1 reported that trimodality treatment (including bladder preservation) had better outcomes for patients with muscle-invasive bladder cancer compared with radical cystectomy. One systematic review2 reported the results of multiple studies: one randomized controlled trial found no difference between bladder preservation treatment versus radical cystectomy, although bladder preservation treatment was associated with increased risk of local or regional recurrence (the strength of evidence was listed as insufficient); multiple cohort studies of bladder preservation treatments versus radical cystectomy reported inconsistent results (the strength of evidence was listed as insufficient). A third systematic review3 reported that, for selected cases, bladder preservation treatment leads to similar overall survival compared to radical cystectomy for muscle invasive bladder cancer.

Six non-randomized studies (NRS)4-9 were identified regarding the clinical effectiveness of bladder preservation treatment in patients with bladder cancer. One NRS4 reported similar rates in overall survival using radical cystectomy or bladder preservation treatment in patients older than 76 years, but stated patients younger than 76 years may have better outcomes undergoing

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radical cystectomy. One NRS5 reported that radical cystectomy had superior outcomes to bladder preservation treatment. Another NRS6 found that a radical or partial cystectomy offered the best overall survival and cancer-specific survival for men over the age of 80 years with T2 bladder cancer when compared to bladder preservation treatment. Another NRS7 reported that after propensity score adjustment, bladder preservation treatment had greater mortality than radical cystectomy, while instrument variable (IV) analysis and simulation suggested that the two treatments were associated with similar survival outcomes. One NRS8 reported no clear survival benefit with octogenarians (patients in their 80s) with either radical cystectomy or bladder preservation treatment. The final NRS9 found that bladder preservation treatment was a viable treatment option within a select patient population with high grade cT1 urothelial cell carcinoma.

One economic evaluation10 was identified regarding the cost-effectiveness of treatments for bladder cancer. The economic evaluation reported that office-based cystoscopy and fulguration was more cost-effective than bladder preservation treatment (transurethral resection of the bladder or TURB) for treating recurrent low-risk non-muscle-invasive bladder cancer.

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REFERENCES SUMMARIZED

Health Technology Assessments No literature identified.

Systematic Reviews and Meta-analyses

1. Arcangeli G, Strigari L, Arcangeli S. Radical cystectomy versus organ-sparing trimodality treatment in muscle-invasive bladder cancer: A systematic review of clinical trials. Crit Rev Oncol Hematol. 2015 Sep;95(3):387-96. PubMed: PM25934521

2. Chou R, Selph S, Buckley D, Gustafson K, Griffin J, Grusing S, et al. Treatment of Nonmetastatic Muscle-Invasive Bladder Cancer [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2015 Jun [cited 2017 Jan 11]. (AHRQ Comparative Effectiveness Reviews). Available from: PubMed: PM2629866

3. Bos MK, Marmolejo RO, Rasch CR, Pieters BR. Bladder preservation with brachytherapy compared to cystectomy for T1-T3 muscle-invasive bladder cancer: a systematic review. J Contemp Brachytherapy [Internet]. 2014 Jun [cited 2017 Jan 11];6(2):191-9. Available from: PubMed: PM25097561

Randomized Controlled Trials No literature identified.

Non-Randomized Studies

4. Chen CL, Liu CY, Cha TL, Hsu CY, Chou YC, Wu ST, et al. Does radical cystectomy outperform other bladder preservative treatments in elderly patients with advanced bladder cancer? J Chin Med Assoc. 2015 Aug;78(8):469-74. PubMed: PM26074367

5. Supit W, Mochtar CA, Santoso RB, Umbas R. Outcomes of radical cystectomy and bladder preservation treatment for muscle-invasive urothelial carcinoma of the bladder. Asian J Surg. 2014 Oct;37(4):184-9. PubMed: PM24637186

6. Trulson JJ, Sharma P, Haden T, Kheterpal E, Pokala N. Comparative survival following different treatment modalities for stage T2 bladder cancer in octogenarians. World J Urol. 2014 Apr;32(2):425-9. PubMed: PM23817891

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7. Bekelman JE, Handorf EA, Guzzo T, Evan PC, Christodouleas J, Resnick MJ, et al. Radical cystectomy versus bladder-preserving therapy for muscle-invasive urothelial carcinoma: examining confounding and misclassification biasin cancer observational comparative effectiveness research. Value Health [Internet]. 2013 Jun [cited 2017 Jan 11];16(4):610-8. Available from: PubMed: PM23796296

8. Martini T, Mayr R, Wehrberger C, Dechet C, Lodde M, Palermo S, et al. Comparison of radical cystectomy with conservative treatment in geriatric (>/=80) patients with muscleinvasive bladder cancer. Int Braz J Urol. 2013 Sep;39(5):622-30. PubMed: PM24267105

9. Badalato GM, Gaya JM, Hruby G, Patel T, Kates M, Sadeghi N, et al. Immediate radical cystectomy vs conservative management for high grade cT1 bladder cancer: is there a survival difference? BJU Int. 2012 Nov;110(10):1471-7. PubMed: PM22487512

Economic Evaluations

10. Al Hussein Al Awamlh B, Lee R, Chughtai B, Donat SM, Sandhu JS, Herr HW. A costeffectiveness analysis of management of low-risk non-muscle-invasive bladder cancer using office-based fulguration. Urology. 2015 Feb;85(2):381-6. PubMed: PM25623694

PREPARED BY: Canadian Agency for Drugs and Technologies in Health Tel: 1-866-898-8439 cadth.ca

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APPENDIX ? FURTHER INFORMATION:

Systematic Reviews and Meta-Analyses

No Comparator

11. Mak RH, Hunt D, Shipley WU, Efstathiou JA, Tester WJ, Hagan MP, et al. Long-term outcomes in patients with muscle-invasive bladder cancer after selective bladderpreserving combined-modality therapy: a pooled analysis of Radiation Therapy Oncology Group protocols 8802, 8903, 9506, 9706, 9906, and 0233. J Clin Oncol [Internet]. 2014 Dec 1 [cited 2017 Jan 11];32(34):3801-9. Available from: PubMed: PM25366678

12. Ploussard G, Daneshmand S, Efstathiou JA, Herr HW, James ND, Rodel CM, et al. Critical analysis of bladder sparing with trimodal therapy in muscle-invasive bladder cancer: a systematic review. Eur Urol. 2014 Jul;66(1):120-37. PubMed: PM24613684

Alternate Comparator

13. Cui Y, Chen H, Liu L, Chen J, Qi L, Zu X. Comparing the Efficiency and Safety of Bipolar and Monopolar Transurethral Resection for Non-Muscle Invasive Bladder Tumors: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A. 2016 Mar;26(3):196-202. PubMed: PM26799841

14. Gakis G, Fahmy O. Systematic Review and Meta-Analysis on the Impact of Hexaminolevulinate- Versus White-Light Guided Transurethral Bladder Tumor Resection on Progression in Non-Muscle Invasive Bladder Cancer. Bladder Cancer [Internet]. 2016 Jul 27 [cited 2017 Jan 11];2(3):293-300. Available from: PubMed: PM27500197

15. Bai Y, Liu L, Yuan H, Li J, Tang Y, Pu C, et al. Safety and efficacy of transurethral laser therapy for bladder cancer: a systematic review and meta-analysis. World J Surg Oncol [Internet]. 2014 Sep 25 [cited 2017 Jan 11];12:301. Available from: PubMed: PM25256383

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