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Prospective trial to identify optimal bladder cancer surveillance protocol: reducing costs while maximizing
Ashish M Kamat1, Jose A Karam, H Barton Grossman
1Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. akamat@mdanderson.org
BJU International
|March 24, 2011
Summary
Cystoscopy alone is the most cost-effective method for detecting bladder cancer recurrence. Adding urinary markers increases costs without improving the detection of invasive bladder cancer.
Area of Science:
- Urology
- Oncology
- Health Economics
Background:
- Bladder cancer surveillance is crucial for early recurrence detection.
- Current surveillance often involves cystoscopy, but adjunctive tests are explored.
Purpose of the Study:
- To evaluate the cost-effectiveness of adding cytological evaluation, NMP22 BladderChek®, and fluorescence in situ hybridization (FISH) UroVysion® to cystoscopy for bladder cancer surveillance.
- To compare five surveillance strategies in patients with a history of non-muscle-invasive bladder cancer.
Main Methods:
- Prospective enrollment of 200 patients with a history of non-muscle-invasive bladder cancer.
- Comparison of five surveillance strategies: cystoscopy alone, cystoscopy with NMP22, cystoscopy with FISH, cystoscopy with cytology, and cystoscopy with NMP22 confirmed by FISH.
- Calculation of cost per cancer detected (CPTD), considering early detection of biomarkers.
Main Results:
- Cancer was detected in 13 patients at study entry.
- Detection rates varied: cystoscopy alone (52%), cystoscopy + NMP22 (56%), cystoscopy + FISH (72%), cystoscopy + cytology (60%), cystoscopy + NMP22/FISH (56%).
- CPTD (including early detection) ranged from $7,692 (cystoscopy alone) to $19,111 (cystoscopy + FISH).
Conclusions:
- Cystoscopy alone is the most cost-effective strategy for surveillance of non-muscle-invasive bladder cancer recurrence.
- The addition of urinary markers increases costs without a significant improvement in detecting invasive disease.
