Resource utilization analysis of dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (DD-MVAC) versus gemcitabine-cisplatin (GC) as neoadjuvant chemotherapy (NAC) for muscle invasive bladder cancer (MIBC).
Bibliographic record
Abstract
474 Background: DD-MVAC and GC are commonly used NAC regimens for MIBC. While efficacy across studies appears similar, the resource utilization burdens have not been compared. Methods: We assessed the resource utilization and cost effectiveness of NAC with GC vs DD-MVAC for MIBC patients (pts) treated at Dana-Farber. Data on chemotherapy administered, supportive medications, relevant procedures, hospitalizations, clinic, infusion, and emergency room visits were collected retrospectively. Results: 147 patients were included, 51 in the DD-MVAC and 86 in the GC group. The two groups had similar baseline pt characteristics except lower mean age (59 vs 67 years, p<0.001) and higher proportion of ECOG-PS=0 (96.1% vs 60.5%, p<0.001) in the DD-MVAC group. The mean cumulative cisplatin dosages were similar (DD-MVAC=284 mg/m2, GC= 257 mg/m3). The DD-MVAC group exhibited a greater use of G-CSF analogues (100% vs 32.6%, p < 0.001), central line placement (28.6% vs 11.8%, p = 0.017), infusion visits/pt (12 vs 8), ER visits (35% vs 18%, p = 0.048), and cardiac imaging (0.98 vs 0.58/pt, p<0.001). Patients receiving GC were more likely to experience delayed chemotherapy cycles (30.2% vs 9.8%, p = 0.008) and required more frequent clinic visits (9 vs 5/pt). The frequency and duration of hospitalization (23.6% vs 13.7% and 0.88 vs 0.49 days/pt, p = 0.46) and rate of grade ≥3 toxicities (32.6% vs 45.1%, p = 0.18) were numerically but not statistically different between the GC and DD-MVAC group. Cost efficacy analysis is pending and will be presented. Conclusions: DD-MVAC and GC exhibit different characteristics in terms of resource utilization as NAC for MIBC. Importantly, excess resource utilization did not clearly favor one of the regimens, although the DD-MVAC group was younger with better ECOG-PS. Given that similar overall delivery of cumulative cisplatin dosage was feasible with both regimens, the values and costs affixed to different resources may impact the selection of DD-MVAC vs GC in different regions of the world.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".