Hexaminolevulinate-induced Fluorescence versus White Light During Transurethral Resection of Noninvasive Bladder Tumor: Does It Reduce Recurrences?

Karaolides, Theocharis; Skolarikos, Andreas; Bourdoumis, Andreas; Konandreas, A.; Mygdalis, Vasilios; Thanos, A.; Deliveliotis, Charalambos

doi:10.1016/j.urology.2012.03.067

Cited by 46 publications

(40 citation statements)

References 22 publications

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“…Using the search strategy described previously, after study assessment there were 12 RCTs [13-24] for analysis in this review. Of these RCTs, two [19,20] were from the same authors or institution, but the extracted outcome data were different.…”

Section: Resultsmentioning

confidence: 99%

Therapeutic Outcome of Fluorescence Cystoscopy Guided Transurethral Resection in Patients with Non-Muscle Invasive Bladder Cancer: A Meta-Analysis of Randomized Controlled Trials

et al. 2013

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ObjectivesTo conduct a meta-analysis of randomized controlled trials (RCTs) to assess the therapeutic outcome of fluorescence cystoscopy (FC) guided transurethral resection (TUR) in non-muscle invasive bladder cancer (NMIBC).Materials and MethodsRelevant RCTs were identified from electronic database (MEDLINE, Embase and the Cochrane Library). The proceedings of relevant congress were also searched. The primary parameters were recurrence rate, the time to fist recurrence, recurrence free survival rate (RFS) and progression rate.Results12 RCTs including 2258 patients, which were identified for analysis in our study. Our study showed that the FC group have lower recurrence rate than the white light cystoscopy (WLC) group with statistically significant difference (OR: 0.5; p<0.00001). The time of the FC group first recurrence delayed significantly 7.39 weeks than WLC group (MD: 7.39 weeks; p<0.0001). There was a statistically significant difference in favor of FC in RFS at 1 yr (HR: 0.69; p<0.00001) and 2 yrs (HR: 0.65; p=0.0004). However, the FC group cannot significantly reduce the rate of progression into muscle invasive bladder cancer compared with the WLC group (OR: 0.85; p=0.39).ConclusionsFC guided TUR was demonstrated to be an effective procedure for delaying recurrence of NMIBC. Unfortunately, FC guided TUR could not significantly decrease the rate of progression into muscle invasive bladder cancer.

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Section: Resultsmentioning

confidence: 99%

Therapeutic Outcome of Fluorescence Cystoscopy Guided Transurethral Resection in Patients with Non-Muscle Invasive Bladder Cancer: A Meta-Analysis of Randomized Controlled Trials

et al. 2013

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“…[13][14][15][16][17][18][19][20][21][22] Systematic reviews and meta-analyses have concluded that BLC with HAL improves recurrence rates, particularly in patients with high-risk bladder tumours.…”

Section: Discussionmentioning

confidence: 99%

“…Among these 33 studies were 10 RCTs of BLC with HAL vs. WLC that were used to meta-analyze sensitivities and specificities. [13][14][15][16][17][18][19][20][21][22] Burger et al recently used raw data of RCTs to metaanalyze recurrence relative risk (RR) for BLC with HAL vs. WLC-assisted TURBT, and this RR (0.761) was used in the baseline decision-tree analysis. 23 …”

Section: Evidence Synthesismentioning

confidence: 99%

“…Input probabilities were calculated from meta-analysis of the existing literature for sensitivities, specificities, and recurrence probabilities. [13][14][15][16][17][18][19][20][21][22] As mentioned, the previous meta-analyzed RR for recurrence was used (0.761; 95% confidence interval [CI] 0.627-0.924). 23 Provincial base outcomes were assessed, including: initial cost, followup cost, five-year amortized cost, cost-difference per case, bed day use, and recurrences.…”

Section: Cost Estimates and Probabilitiesmentioning

confidence: 99%

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

Klaassen¹,

Li²,

Kassouf³

et al. 2017

CUAJ

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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.

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“…When using florescent light cystoscopy, both 5-aminolevulinic acid and hexaminolevulinate are shown to be equally effective at detecting CIS [37]. In addition, the use of HAL when resecting tumours is shown to reduce tumour recurrence in CIS and also in multifocal tumours [39]. Despite the benefits of fluorescent light cystoscopy, one of its major drawbacks is the high false positive rates.…”

Section: White Light Cystoscopy Vs Fluorescent Light Cystoscopymentioning

confidence: 99%

The Changing Incidence of Carcinoma In-Situ of the Bladder Worldwide

Ranasinghe¹,

Persad²

2013

Advances in the Scientific Evaluation of Bladder Cancer and Molecular Basis for Diagnosis and Treatment

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Hexaminolevulinate-induced Fluorescence versus White Light During Transurethral Resection of Noninvasive Bladder Tumor: Does It Reduce Recurrences?

Cited by 46 publications

References 22 publications

Therapeutic Outcome of Fluorescence Cystoscopy Guided Transurethral Resection in Patients with Non-Muscle Invasive Bladder Cancer: A Meta-Analysis of Randomized Controlled Trials

Therapeutic Outcome of Fluorescence Cystoscopy Guided Transurethral Resection in Patients with Non-Muscle Invasive Bladder Cancer: A Meta-Analysis of Randomized Controlled Trials

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

The Changing Incidence of Carcinoma In-Situ of the Bladder Worldwide

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