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Cost-effectiveness of brachytherapy compared to cystectomy for treatment of muscle-invasive bladder cancer

Spoor, D.S. (2015) Cost-effectiveness of brachytherapy compared to cystectomy for treatment of muscle-invasive bladder cancer.

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Abstract:This study is aimed at determining the health economic impact of open radical cystectomy, robot-assisted cystectomy and robot-assisted brachytherapy as initial treatments for patients with a solitary T1G3, T2 or T3a, <5 cm, N0 and M0 bladder tumor. A Markov Monte-Carlo cost-effectiveness model was created to simulate the outcome of this cohort. This analysis has shown that brachytherapy is a more expensive treatment but also has a better effectiveness compared to radical cystectomy. The incremental cost-effectiveness ratio was €15.578,96 per QALY which is below a willingness-to-pay threshold of €25.000,-. Deterministic sensitivity analysis showed that long term utilities experienced after cystectomy and brachytherapy had the biggest impact on the cost-effectiveness. These were also the only input parameters for which a variation of base value could result in decision for radical cystectomy as preferred treatment strategy. Probabilistic sensitivity analysis showed that, if uncertainties of all input parameters were taken into account, the chance is 67,3% that brachytherapy is the preferred treatment. Robot-assisted brachytherapy is the most cost-effective treatment strategy and should therefore be the preferred treatment strategy for a selected group of muscle-invasive bladder cancer patients. Further research should be done to obtain more accurate values for the post treatment utilities.
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:44 medicine, 83 economics
Programme:Health Sciences MSc (66851)
Link to this item:http://purl.utwente.nl/essays/67861
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