Cost–utility analysis of the GC versus MVAC regimens for the treatment of locally advanced or metastatic bladder cancer

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Abstract
A cost–utility analysis was conducted to compare the gemcitabine (Gemzar®)/cisplatin and methotrexate/vinblastine(Velban®)/doxorubicin (Doxil®)/cisplatin regimens in the treatment of locally advanced or metastatic bladder cancer. The analysis combined theresults of a cost analysis of a head-to-head Phase III clinical trial with those from a cross-sectional utility study. The analysis was performed from the perspective of the National Health Service in England and Wales. Medical resource use was obtained from the clinical trial database, from which patient-level cost streams were estimated for each treatment group. Unit costs for each resource utilization component were sought from the latest UK cost sources available at the time of analysis (2001). The distribution of the mean total and incremental costs for each group was simulated via bias-adjusted bootstrapping. Time trade-off utilities were derived from the utility study, which aimed to value the superior toxicity profile associated with gemcitabine/cisplatin, given comparable efficacy, in a discrete choice model assessing toxicity attributes and risks. The mean incremental cost of gemcitabine/cisplatin over methotrexate/vinblastine/doxorubicin/cisplatin was estimated to be approximately £2976 per patient, based on a mean of 4.65 cycles per patient treated with gemcitabine/cisplatin compared with a mean of 3.92 cycles per methotrexate/vinblastine/doxorubicin/cisplatin patient. When combined with the utility estimates, this resulted in an incremental cost-effectiveness ratio of approximately £22,925 per quality-adjusted life year gained associated with the choice of gemcitabine/cisplatin over methotrexate/vinblastine/doxorubicin/cisplatin. A 95% confidence interval for the incremental cost-effectiveness ratio was calculated to range from £12,911 to 33,589 per quality-adjusted life year gained. The incremental cost of gemcitabine/cisplatin is primarily due to the direct costs of chemotherapy given minimal cost offsets. However, an incremental cost per quality-adjusted life year ratio in the range of £20,000–30,000 per quality-adjusted life year gained suggested that the regimen is reasonable value for money in England and Wales.