{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:45:50Z","timestamp":1787013950926,"version":"build-2736575974"},"reference-count":16,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,3,16]],"date-time":"2024-03-16T00:00:00Z","timestamp":1710547200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Radical cystectomy (RC) is the standard of care (SOC) in BCG\u2010unresponsive NMIBC and is associated with a significant health\u2010related quality\u2010of\u2010life burden. Recently, promising results have been published on Gemcitabine\/Docetaxel, Pembrolizumab, and Hyperthermic Intravesical Chemotherapy (HIVEC) as salvage therapy options trying to increase the rate of bladder preservation. Here, we performed a Cost\u2010Effectiveness\u2010Analysis of those treatment modalities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>\n                      We developed a Markov model from a payer's perspective drawing on clinical data of single\u2010arm trials testing intravesical gemcitabine\/docetaxel and pembrolizumab in BCG\u2010unresponsive NMIBC, as well as clinical data from patients receiving hyperthermic intravesical chemotherapy HIVEC (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200929) as intravesical salvage chemotherapy at our uro\u2010oncological centre in Cologne. Costs were simulated utilising a non\u2010commercial diagnosis\u2010related groups grouper, utilities were derived from comparable cost\u2010effectiveness studies. We used a Monte Carlo simulation to identify the optimal treatment, comparing the incremental cost effectiveness ratios (ICERs) at a willingness\u2010to\u2010pay threshold of \u20ac50\u2009000\u2009(euro)\/quality\u2010adjusted life year (QALY).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over a horizon of 10\u2009years, gemcitabine\/docetaxel, HIVEC, and pembrolizumab were associated with costs of \u20ac48\u2009353, \u20ac64\u2009438, and \u20ac204\u2009580, as well as a gain of QALYs of 6.16, 6.48, and 6.00, resulting in an ICER of \u20ac26\u2009482, \u20ac42\u2009567, and \u20ac184\u2009533 respectively, in comparison to RC with total costs of \u20ac21\u2009871 and a gain of QALYs of 5.01. Monte Carlo simulation identified HIVEC as the treatment of choice under assumption of a WTP of &lt;\u20ac50\u2009000.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Considering a WTP of &lt;\u20ac50\u2009000\/QALY, gemcitabine\/docetaxel and HIVEC are highly cost\u2010effective therapeutic options in BCG\u2010refractory NMIBC, while RC remains the cheapest option. At its current price, pembrolizumab would only be cost\u2010effective assuming a price reduction of at least 70%.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.16332","type":"journal-article","created":{"date-parts":[[2024,3,16]],"date-time":"2024-03-16T03:34:30Z","timestamp":1710560070000},"page":"582-588","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["<scp>Cost\u2010effectiveness analysis<\/scp>\n                    of different treatment modalities in\n                    <scp>BCG<\/scp>\n                    \u2010unresponsive\n                    <scp>NMIBC<\/scp>"],"prefix":"10.1111","volume":"134","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3993-7974","authenticated-orcid":false,"given":"Constantin","family":"Rieger","sequence":"first","affiliation":[{"name":"Department of Urology, Urologic Oncology, Robot\u2010Assisted and Specialized Urologic Surgery University of Cologne  Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Schl\u00fcchtermann","sequence":"additional","affiliation":[{"name":"Faculty of Law, Business and Economics University of Bayreuth  Bayreuth Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8250-5522","authenticated-orcid":false,"given":"Enno","family":"Storz","sequence":"additional","affiliation":[{"name":"Department of Urology, Urologic Oncology, Robot\u2010Assisted and Specialized Urologic Surgery University of Cologne  Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas","family":"Kastner","sequence":"additional","affiliation":[{"name":"Department of Urology, Urologic Oncology, Robot\u2010Assisted and Specialized Urologic Surgery University of Cologne  Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3925-9653","authenticated-orcid":false,"given":"David","family":"Pfister","sequence":"additional","affiliation":[{"name":"Department of Urology, Urologic Oncology, Robot\u2010Assisted and Specialized Urologic Surgery University of Cologne  Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2511-3664","authenticated-orcid":false,"given":"Axel","family":"Heidenreich","sequence":"additional","affiliation":[{"name":"Department of Urology, Urologic Oncology, Robot\u2010Assisted and Specialized Urologic Surgery University of Cologne  Cologne Germany"},{"name":"Department of Urology Medical University Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,3,16]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOU.0000000000000078"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2014.01.006"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcpo.2022.100326"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clgc.2019.12.004"},{"issue":"6","key":"e_1_2_10_6_1","first-page":"E216","article-title":"Prognostic significance of Bacillus Calmette\u2010Gu\u00e9rin failure classification in non\u2010muscle\u2010invasive bladder cancer","volume":"110","author":"Shirakawa H","year":"2012","journal-title":"BJU Int"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s41669-023-00392-4"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/JU.0000000000000688"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(21)00147-9"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urolonc.2021.07.019"},{"key":"e_1_2_10_11_1","unstructured":"European Association of Urology.Guidelines non\u2010muscle\u2010invasive bladder cancer. Available at: Accessed on: 01\u201011\u20102023 https:\/\/uroweb.org\/guidelines\/non\u2010muscle\u2010invasive\u2010bladder\u2010cancer"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(05)64045-1"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2008.07.031"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/JU.0000000000001515"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2021.04.166"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urolonc.2021.03.004"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2035807"}],"container-title":["BJU International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bju.16332","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T16:10:58Z","timestamp":1761754258000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/10.1111\/bju.16332"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,16]]},"references-count":16,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,10]]}},"alternative-id":["10.1111\/bju.16332"],"URL":"https:\/\/doi.org\/10.1111\/bju.16332","archive":["Portico"],"relation":{},"ISSN":["1464-4096","1464-410X"],"issn-type":[{"value":"1464-4096","type":"print"},{"value":"1464-410X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,16]]},"assertion":[{"value":"2024-03-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}