Contemporary cost-consequence analysis of blue light cystoscopy with hexaminolevulinate in non-muscle-invasive bladder cancer

Abstract

Introduction: Previous studies have suggested cost-savings using blue light cystoscopy (BLC) with hexaminolevulinate (HAL) compared to white light cystoscopy (WLC) during transurethral resection of bladder tumour (TURBT) for non-muscle-invasive bladder cancer (NMIBC), secondary to improvements in recurrence and progression rates; however, these studies have used 'best case scenario' recurrence rate probabilities, thus decreasing generalizability of the findings. The objective of this study was to perform a contemporary cost-effectiveness assessment of BLC compared to WLC at the time of TURBT. Methods: A decision and cost-effectiveness model with a five-year time horizon following initial TURBT was used. The model was created from the healthcare payer perspective. Comprehensive literature review was performed to obtain contemporary recurrence and progression rates. These values were meta-analyzed for inclusion into the model. Cost variables included in the model were from three large Canadian bladder cancer centres. Model outputs were number of recurrences prevented, bed days saved, and overall costs. One-way sensitivity and scenario analyses were performed to assess model robustness. Results:The five-year amortized cost of using BLC with HAL on all incident NMIBC compared to WLC assistance was $4 832,908 for Ontario (n=4696; $1372/patient); $1 168 968 for British Columbia (n=1204; $1295/patient); and $2 484, 872 (n=2680; $1236/patient) for Quebec. Use of BLC with HAL would result in 87-338 fewer recurrences annually. On sensitivity/scenario analyses for Ontario data, if BLC with HAL equipment were provided to the province at no cost, five-year costs would be $4 158 814 and $1181 cost per patient. If BLC with HAL were only used for cystoscopically appearing aggressive tumours, the five-year amortized cost would be $3 874 098, with a cost per patient of $1222. If there was a 20% or 50% improvement in progression rates with BLC plus HAL, the five-year amortized cost would be $2 660 529 and -$598 039 (cost-saving), respectively. Conclusions: TURBT using BLC with HAL for patients with NMIBC is associated with a five-year cost of approximately $1-5 million for jurisdictions of 4-13 million people. Although this translates to a cost of $1200-1400 per patient for their initial TURBT, BLC with HAL improves patients care, reduces recurrences, and decreases the need for hospital beds after TURBT. If this diagnostic procedure eventually improves progression rates, there would be considerably improved cost-effectiveness.

Hexaminolevulinate blue light cystoscopy (Hal) assisted transurethral resection of the bladder tumour vs white light transurethral resection of the bladder tumour in non-muscle invasive bladder cancer (NMIBC) : a retrospective analysis.

“…At the present time there are no long-term results on disease progression and overall survival, however it is desirable that these variables will decrease. Meanwhile the use of HAL-TURB leads to a reduction of further hospitalizations which in turn reduces hospital costs (12).…”

<p>Humanistic and Economic Burden of Non-Muscle Invasive Bladder Cancer: Results of Two Systematic Literature Reviews</p>

“…Studies reported on a range of different findings. Of the 37 studies identified from SLR searches, fifteen were cost studies, of which one evaluated total healthcare costs of bladder cancer in the US; 75 one was a US Markov model of healthcare costs by disease risk; 76 four were US database studies evaluating varying provider-level treatment intensity among Medicare beneficiaries aged ≥65 years; 12,13,77,78 three assessed diagnosis and monitoring costs; [79][80][81] three assessed different imaging technologies; [82][83][84] and two evaluated intravesical chemotherapy post-TURBT. 85,86 In addition, three budget impact models (BIMs) and eighteen CEAs were identified from SLR searches, of which twelve evaluated TURBT, mainly comparing diagnostic imaging during the procedure as well as comparing TURBT to other procedures or procedure setting.…”

The Role of New Technologies in the Diagnosis and Surveillance of Non-Muscle Invasive Bladder Carcinoma: A Prospective, Double-Blinded, Monocentric Study of the XPERT© Bladder Cancer Monitor and Narrow Band Imaging© Cystoscopy

“…In conjunction with WLC, BLC may improve the diagnostic accuracy of cystoscopy and facilitate a more complete tumor resection, thereby reducing the rate of tumor recurrence in NMIBC disease [10]. However, BLC is more expensive and is logistically complex compared to WLC [11]. Moreover, BLC results can be confounded by acute and chronic inflammation, such as the state of the bladder during or after a urinary tract infection(s) or in instances of traumatic penetration of the cystoscope into the bladder.…”