Cost-Efficacy of Immediate Mitomycin C Instillation for Non-Muscle-Invasive Bladder Cancer

By Patrick Daly - Last Updated: March 9, 2022

According to a study published in European Urology Open Science, bladder cancer contributes a significant amount to the public health burden in the European Union. Aiming to identify feasible treatment and maintenance regimens, Anouk E. Hentschel and colleagues examined the cost-effectiveness of immediate mitomycin C (MMC) administration within one day of surgery, and reported that it reduced risk of recurrence after removal of a bladder tumor compared to delayed MMC instillation within two weeks.

The economic analysis utilized the data from a randomized controlled trial comprised of 2,234 Dutch patients with non-muscle-invasive bladder cancer (NMIBC) and a three-year follow-up period. The effect of treatment was measured via time to recurrence and recurrence-free survival. Health care utilization and related costs were assessed in the context of the Netherlands treatment guidelines for patients with NMIBC.

According to the study’s authors, the time to recurrence in the immediate MMC instillation group was significantly longer versus in delayed MMC instillation (27.31 vs. 24.97 months; adjusted mean difference = 2.21 months; 95% confidence interval [CI], 1.58–2.84). Moreover, the proportion of patients who achieved recurrence-free survival was significantly higher for immediate MMC instillation patients than in delayed MMC patients (0.65 vs. 0.56; adjusted mean difference = 0.08; 95% CI, 0.06–0.11). Finally, the authors estimated that total mean health care cost per patient was significantly lower for immediate MMC instillation than for delayed MMC instillation (€22,959 vs. €24,624; adjusted mean difference = –€1350; 95% CI, –€1,799 to –€900).

The authors acknowledged that their study was subject to the inherent limitations of retrospective analysis; however, they ultimately asserted that, “from a health care perspective, immediate MMC instillation is more effective and less expensive compared to delayed MMC instillation.”

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