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Critical Appraisal of Decision Models Used for the Economic Evaluation of Bladder Cancer Screening and Diagnosis: A Systematic Review

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Abstract

Background and Objective

Bladder cancer is common among current and former smokers. High bladder cancer mortality may be decreased through early diagnosis and screening. The aim of this study was to appraise decision models used for the economic evaluation of bladder cancer screening and diagnosis, and to summarise the main outcomes of these models.

Methods

MEDLINE via PubMed, Embase, EconLit and Web of Science databases was systematically searched from January 2006 to May 2022 for modelling studies that assessed the cost effectiveness of bladder cancer screening and diagnostic interventions. Articles were appraised according to Patient, Intervention, Comparator and Outcome (PICO) characteristics, modelling methods, model structures and data sources. The quality of the studies was also appraised using the Philips checklist by two independent reviewers.

Results

Searches identified 3082 potentially relevant studies, which resulted in 18 articles that met our inclusion criteria. Four of these articles were on bladder cancer screening, and the remaining 14 were diagnostic or surveillance interventions. Two of the four screening models were individual-level simulations. All screening models (n = 4, with three on a high-risk population and one on a general population) concluded that screening is either cost saving or cost effective with cost-effectiveness ratios lower than $53,000/life-years saved. Disease prevalence was a strong determinant of cost effectiveness. Diagnostic models (n = 14) assessed multiple interventions; white light cystoscopy was the most common intervention and was considered cost effective in all studies (n = 4). Screening models relied largely on published evidence generalised from other countries and did not report the validation of their predictions to external data. Almost all diagnostic models (n = 13 out of 14) had a time horizon of 5 years or less and most of the models (n = 11) did not incorporate health-related utilities. In both screening and diagnostic models, epidemiological inputs were based on expert elicitation, assumptions or international evidence of uncertain generalisability. In modelling disease, seven models did not use a standard classification system to define cancer states, others used risk-based, numerical or a Tumour, Node, Metastasis classification. Despite including certain components of disease onset or progression, no models included a complete and coherent model of the natural history of bladder cancer (i.e. simulating the progression of asymptomatic primary bladder cancer from cancer onset, i.e. in the absence of treatment).

Conclusions

The variation in natural history model structures and the lack of data for model parameterisation suggest that research in bladder cancer early detection and screening is at an early stage of development. Appropriate characterisation and analysis of uncertainty in bladder cancer models should be considered a priority.

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Authors and Affiliations

  1. Health Economics and Decision Science, School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK

    Olena Mandrik & James Chilcott

  2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Anne I. Hahn & Ann G. Zauber

  3. Department of Oncology and Metabolism, University of Sheffield, Sheffield, S10 2RX, UK

    James W. F. Catto & Marcus Cumberbatch

  4. Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK

    James W. F. Catto & Marcus Cumberbatch

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  1. Olena Mandrik
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Correspondence to Olena Mandrik.

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Funding

This study was supported by the Yorkshire Cancer Research UK (Grant number RA/2019/R1/004). James W.F. Catto is funded by an NIHR Research Professorship.

Conflicts of interest/competing interests

James W.F. Catto reported receiving reimbursement for consultancy from AstraZeneca, Ferring, Roche and Janssen; speaker fees from Bristol Myers Squibb, Merck Sharp & Dohme, Janssen, Astellas, Nucleix and Roche; honoraria for membership in advisory boards from Ferring, Roche, Gilead, Photocure, Bristol Myers Squibb, QED Therapeutics and Janssen; and research funding from Roche. Olena Mandrik, Anne I. Hahn, Ann G. Zauber, Marcus Cumberbatch and James Chilcott have no conflicts of interest that are directly relevant to the content of this article.

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Authors’ contributions

The work reported in the paper has been performed by the authors, unless clearly specified in the text. Conceptualization: OM, AIH, AGZ, JC; methodology: OM, JC; analysis and interpretation of data: OM, AIH; drafting of the manuscript: OM, AIH, JWFC, AGZ, MC, JC; funding acquisition: JWFC, JC.

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Mandrik, O., Hahn, A.I., Catto, J.W.F. et al. Critical Appraisal of Decision Models Used for the Economic Evaluation of Bladder Cancer Screening and Diagnosis: A Systematic Review. PharmacoEconomics 41, 633–650 (2023). https://doi.org/10.1007/s40273-023-01256-9

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