Cost-effectiveness analysis of transurethral resection of bladder tumor with photodynamic diagnosis with 5-aminolevulinic acid hydrochloride for non-muscle invasive bladder cancer

OBJECTIVE: Photodynamic diagnosis (PDD)-assisted transurethral resection of bladder tumor (TURBT) is effective for preventing recurrence in patients with non-muscle invasive bladder cancer (NMIBC). However, the cost of PDD-TURBT is higher than that of standard white-light TURBT (WL-TURBT), given the use of photodynamic devices and 5-aminolevulinic acid hydrochloride (ALA). Accordingly, we evaluated the cost-effectiveness of PDD-TURBT with ALA. METHODS: This retrospective cohort study included patients with NMIBC who underwent TURBT at Kochi University Hospital (2010‒2021), categorized by their initial TURBT into the PDD-TURBT and WL-TURBT groups. We evaluated cost-effectiveness and quality-adjusted life years (QALYs) using survival analysis with a multistate model, which defined six health states: disease-free, first recurrence, second recurrence, three or more recurrences, total bladder removal, and death. Quality of life (QOL) values for each state were adopted from previous studies. RESULTS: Overall, 303 patients were analyzed (PDD-TURBT, n = 111; WL-TURBT, n = 192). The mean age was 73.3 years, and 232 (76.6%) were male. Adjusted 3-year disease-free survival rates were 0.60 and 0.40 in the PDD-TURBT and WL-TURBT groups, respectively. The incremental cost-effectiveness ratio (ICER) for PDD-TURBT was ¥309,812 per 1-year of disease-free time and ¥802,192 per 1-life year. Assuming a QOL of 0.87, the ICER was ¥922,060 (£5,123) per QALY, below the recommended threshold of "£20,000 to £30,000/QALY" suggested by the National Institute for Health and Care Excellence (NICE). CONCLUSIONS: Our analysis demonstrated that the cost of PDD-TURBT is lower than the NICE-recommended £20,000-£30,000/QALY and is cost-effective compared with WL-TURBT.