ArticleThe Journal of urology2026
Cost-Effectiveness of Immune Checkpoint Inhibitor Therapy Plus Bacillus Calmette-Guérin for High-Risk Nonmuscle-Invasive Bladder Cancer: Analyses of CREST, POTOMAC, and ALBAN.
Article in The Journal of urology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed.
- With Great Cost Comes Great Responsibility: Who Will Own the Rising Costs of Bladder Cancer Care?The Journal of urology · 2026Article
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Authors and funding
10 authors.
Funding
Abstract
purposeThree recent trials evaluated immune checkpoint inhibitors (ICIs) + bacillus Calmette-Guérin (BCG) for treatment of high-risk nonmuscle-invasive bladder cancer (NMIBC). Two of these trials (CREST, POTOMAC) demonstrated that ICI + BCG improved event-free survival compared with BCG alone but resulted in higher rates of treatment-related adverse events. In this article, we evaluated the cost-effectiveness of ICI + BCG compared with BCG alone. We then created a publicly available cost-effectiveness calculator to facilitate future NMIBC drug value comparisons. MATERIALS AND
methodsWe used a Markov model to compare sansalimab + BCG with induction and maintenance BCG alone for BCG-naïve high-risk NMIBC. Efficacy and toxicity probabilities were extracted from the CREST trial. One-way and probabilistic sensitivity analyses were performed. Incremental cost-effectiveness ratios were compared using a willingness-to-pay threshold of $100,000/quality-adjusted life year (QALY). Analyses were repeated using POTOMAC and ALBAN data.
resultsFrom a US Medicare payer's perspective, the combination of sasanlimab + BCG resulted in 0.03 additional QALYs (6.12 vs 6.09) at an additional cost of $145,940 relative to BCG alone. Combination therapy was found not to be cost-effective over a lifetime horizon (incremental cost-effectiveness ratio = $6,316,217/QALY). On one-way sensitivity analysis, the combination of sasanlimab + BCG became cost-effective only if the cost of sasanlimab was reduced by > 94% (to $1399/treatment). Similar findings were found from a UK perspective and with data from POTOMAC/ALBAN.
conclusionsICI + BCG is not cost-effective as a combination therapy relative to BCG alone. Further efforts are needed to improve the efficacy/toxicity profile of novel therapies, while continued scrutiny of the health system cost implications of new agents remains warranted.
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