旨在比较与高危非肌层浸润性膀胱癌 (HRNMIBC) 替代膀胱镜监测方案相关的临床、经济和健康效用结果。我们对 100 000 名患者的假设队列进行了真实世界临床数据驱动的微观模拟70 岁时诊断出患有 HRNMIBC。该队列被模拟接受五项指南推荐的替代监测方案，以及两种假设方案（监测强度升级和降级），其监测强度分别略高于和低于指南推荐的方案。我们从美国医疗保健支付者的角度评估了肌层浸润性膀胱癌 (MIBC) 的 10 年累积发病率、癌症特异性生存率 (CSS)、总体生存率 (OS) 和成本效益。指南推荐的监测方案导致 MIBC 的 10 年累积发病率估计为 11.0% 至 11.6%，CSS 为 95.0% 至 95.2%，OS 为 69.7% 至 69.8%。监测强度升级导致 MIBC 10 年累积发生率为 10.5%（95% 置信区间 [CI] 10.3-10.7%），CSS 为 95.4%（95% CI 95.2-95.5%），OS 为 69.9%（ 95% CI 69.6-70.1%)、11.9% (95% CI 11.7-12.1%)、94.9% (95% CI 94.8-95.1%) 和 69.6% (95% CI 69.3-69.9%) 分别为监视强度降级。通过增加监测强度，10 年内预防另一次 MIBC 进展所需治疗的人数≥80 人，为避免另一次癌症相关死亡所需治疗的人数≥257 人。与监测强度降级相比，更高强度的治疗方案每增加一个质量调整生命年，就会产生≥336 000美元的增量成本，这远远超过了传统的支付意愿阈值，每预防额外的MIBC进展，就会产生≥686 000美元的增量成本，并且每避免额外的癌症相关死亡率，可节省 220 万美元以上。在对新诊断为 HRNMIBC 的患者进行大范围膀胱镜监测强度的微观模拟测试中，适度的监测降级似乎与 10 年 OS 的微不足道的变化相关，而且具有成本效益与更高强度的监测方案相比。这些结果表明，适度降低监测级别可以降低护理成本，同时不会影响许多患者的预期寿命。© 2024 BJU International。

To compare the clinical, economic, and health utility outcomes associated with alternative cystoscopic surveillance regimens for high-risk non-muscle-invasive bladder cancer (HRNMIBC).We performed real-world clinical data-driven microsimulations of a hypothetical cohort of 100 000 patients diagnosed with HRNMIBC at age 70 years. The cohort was simulated to undergo alternative surveillance regimens recommended by five guidelines, and two hypothetical regimens-surveillance intensity escalation and de-escalation-which had a surveillance intensity moderately higher and lower, respectively, than the guideline-recommended regimens. We evaluated the 10-year cumulative incidence of muscle-invasive bladder cancer (MIBC), cancer-specific survival (CSS), overall survival (OS), and cost-effectiveness from a United States healthcare payer perspective.The guideline-recommended surveillance regimens led to an estimated 10-year cumulative incidence of MIBC ranging from 11.0% to 11.6%, CSS 95.0% to 95.2%, and OS 69.7% to 69.8%. Surveillance intensity escalation resulted in a 10-year cumulative incidence of MIBC of 10.5% (95% confidence interval [CI] 10.3-10.7%), CSS of 95.4% (95% CI 95.2-95.5%), and OS of 69.9% (95% CI 69.6-70.1%), vs 11.9% (95% CI 11.7-12.1%), 94.9% (95% CI 94.8-95.1%), and 69.6% (95% CI 69.3-69.9%), respectively, from surveillance intensity de-escalation. By increasing surveillance intensity, the number-needed-to-treat to prevent one additional MIBC progression over 10 years was ≥80, and ≥257 to avoid one additional cancer-related mortality. Compared to surveillance intensity de-escalation, higher-intensity regimens incurred an incremental cost of ≥$336 000 per incremental quality-adjusted life year gained, which well exceeded conventional willingness-to-pay thresholds, ≥$686 000 per additional MIBC progression prevented, and ≥$2.2 million per additional cancer-related mortality avoided.In microsimulations testing a wide range of cystoscopic surveillance intensity for patients newly diagnosed with HRNMIBC, moderate surveillance de-escalation appears associated with an insignificant change in 10-year OS and furthermore is cost-effective vs higher-intensity surveillance regimens. These results suggest that moderate surveillance de-escalation can reduce costs of care without compromising life expectancy for many patients.© 2024 BJU International.