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Because bladder cancer is the most expensive malignancy to treat per patient, decisions regarding the optimal treatment strategy should consider costs.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>A Markov Monte\u2010Carlo cost\u2010effectiveness model was created to simulate the outcomes of a cohort of patients with incident, high\u2010risk, T1G3 bladder cancer. Treatment options included immediate cystectomy and conservative therapy with intravesical <jats:italic>Bacillus<\/jats:italic> Calmette\u2010Guerin (BCG). The base case was a man aged 60 years. Parameter uncertainty was assessed with probabilistic sensitivity analyses. Scenario analyses were used to explore the 2 strategies among patients stratified by age and comorbidity.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>The quality\u2010adjusted survival with immediate cystectomy and BCG therapy was 9.46 quality\u2010adjusted life years (QALYs) and 9.39 QALYs, respectively. The corresponding mean per\u2010patient discounted lifetime costs (in 2005 Canadian dollars) were $37,600 and $42,400, respectively. At a willingness\u2010to\u2010pay threshold of $50,000 per QALY, the probability that immediate cystectomy was cost\u2010effective was 67%. Immediate cystectomy was the dominant (more effective and less expensive) therapy for patients aged &lt;60 years, whereas BCG therapy was dominant for patients aged &gt;75 years. With increasing comorbidity, BCG therapy was dominant at lower age thresholds.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>Compared with BCG therapy, immediate radical cystectomy for average patients with high\u2010risk, T1G3 bladder cancer yielded better health outcomes and lower costs. Tailoring therapy based on patient age and comorbidity may increase survival while yielding significant cost\u2010savings for the healthcare system. Cancer 2009. \u00a9 2009 American Cancer Society.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.24634","type":"journal-article","created":{"date-parts":[[2009,8,14]],"date-time":"2009-08-14T15:44:58Z","timestamp":1250264698000},"page":"5450-5459","source":"Crossref","is-referenced-by-count":59,"title":["Cost\u2010effectiveness analysis of immediate radical cystectomy versus intravesical <i>Bacillus<\/i> Calmette\u2010Guerin therapy for high\u2010risk, high\u2010grade (T1G3) bladder cancer"],"prefix":"10.1002","volume":"115","author":[{"given":"Girish S.","family":"Kulkarni","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shabbir M. 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