<p>Humanistic and Economic Burden of Non-Muscle Invasive Bladder Cancer: Results of Two Systematic Literature Reviews</p>

Abstract

Purpose: Non-muscle invasive bladder cancer (NMIBC) is a malignancy restricted to the inner lining of the bladder. Intravesical Bacillus Calmette-Guerin (BCG) following transurethral resection of the bladder tumor is the mainstay first-line treatment for high-risk NMIBC patients. Two systematic literature reviews (SLRs) were conducted to further assess the current evidence on BCG use in NMIBC and the humanistic and economic burden of disease. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, Embase ® and MEDLINE ® were searched using the Ovid platform to identify interventional or real-world evidence studies on the health-related quality of life (HRQoL) and economic burden in NMIBC. Limited evidence was found from initial economic SLR searches in NMIBC, so additional targeted searches for bladder cancer were conducted to expand findings. Results: Fifty-nine publications were included in the HRQoL SLR, of which 23 reported HRQoL and symptoms in NMIBC. At diagnosis, HRQoL was comparable with population norms but worsened considerably 2 years following diagnosis. Maintenance therapy with intravesical BCG was associated with reduced HRQoL, and treatment-related adverse events (AEs) resembled typical NMIBC symptoms. Twenty-two studies reported decreasing BCG compliance over time. Common AEs with BCG were frequent urination, lower urinary tract symptoms, pain, and hematuria. Forty-two publications were included in the economic SLR, of which nine assessed healthcare costs and resource use in NMIBC or bladder cancer. Highrisk disease and high-intensity treatment were associated with increased healthcare costs. Conclusion: NMIBC has a considerable symptomatic, HRQoL, and economic burden. Symptoms persisted and HRQoL worsened despite intravesical BCG treatment. NMIBC is a costly disease, with higher healthcare costs associated with increased risk of disease progression and recurrence. There is a high unmet need for safe and effective treatments that reduce the risk of disease progression and recurrence, provide symptomatic relief, and improve HRQoL for patients.

Diagnostic Accuracy of Novel Urinary Biomarker Tests in Non–muscle-invasive Bladder Cancer: A Systematic Review and Network Meta-analysis

“…In general, NMIBC has been shown to have considerable symptomatic health-related quality of life and economic burden [3,47]. The reduction of cystoscopy frequency as interventional procedures is not only to potentially improve the quality of life, but also to improve the value-based care of NMIBC.…”

“…In the past decades, several diagnostic urinary biomarkers have been developed with the aim to detect recurrences while avoiding unnecessary cystoscopies. Repeated cystoscopies are uncomfortable for the patient and are one of the reasons for the high cost associated with bladder cancer, especially NMIBC [3]. Some of these urinary biomarkers, such as nuclear matrix protein 22 (NMP22), bladder tumor antigen (BTA), UroVysion (fluorescence in situ hybridization), and ImmunoCyt/uCyt+ [4], have been approved by the Food and Drug Administration (FDA) and European Medicines Agency (EMA); these are commercially available as urinary biomarker tests (UBTs).…”

Bladder Cancer Extracellular Vesicles Elicit a CD8 T Cell-Mediated Antitumor Immunity

“…Approximately 25–30% of BC patients exhibit muscle-invasive (MI) disease, and 50% of these MIBC patients will develop metastatic disease, which is associated with poor 5-year survival rates [ 15 ]. High tumor recurrence rates and the high morbidity in NMI BC and mortality associated with MI BC make BC one of the most expensive cancers to treat and manage, with the highest lifetime treatment cost per patient owing to the need for constant clinical visits to monitor for potential future tumor development [ 16 , 17 , 18 ]. Therefore, better therapeutic options for BC patients are needed, such as patient-specific therapies capable of reducing the high tumor recurrence.…”

Clinical utility of urine DNA for noninvasive detection and minimal residual disease monitoring in urothelial carcinoma.

“…In addition, approximately 75% of new cases are non-muscle-invasive bladder cancer (NMIBC); 70% of these patients will relapse, and 15% will progress within 5 years (8). Among all cancers, BC, especially NMIBC, has the highest lifetime treatment costs per patient, with higher healthcare costs associated with an increased risk of disease progression and recurrence (9). Two-thirds of UTUC cases are reportedly invasive at the time of diagnosis (10,11) and have a relatively low survival rate.…”