Should we screen for bladder cancer in a high‐risk population?

Abstract

BACKGROUND.The U.S. Food and Drug Administration recently approved screening high‐risk patients for bladder cancer using urine‐based markers. The cost and life‐years saved associated with bladder cancer screening were evaluated.METHODS.A Markov model was created to estimate cumulative cancer‐related costs and efficacy of screening (vs. no screening) of a high‐risk population for bladder cancer using a urine‐based tumor marker over a 5‐year period. Assumptions were based on literature review of survival and progression rates for patients with bladder cancer and costs associated with different bladder cancer disease states.RESULTS.Screening for bladder cancer in a population with a 4% incidence of bladder cancer resulted in a gain of 3.0 life years per 1000 subjects at a cost savings of $101,000 for the population, assuming a 50% downstaging in the screened population from muscle‐invasive to nonmuscle‐invasive disease. One‐way sensitivity analyses found that screening is the most cost‐effective strategy if cancer incidence is >1.6%, tumor marker costs <$126, marker sensitivity is >26%, marker specificity is >54%, downstaging with screening is >20%, and office cystoscopy costs <$694. Varying costs of cystectomy, transurethral resection of bladder tumor (TURBT), chemotherapy, end‐of‐life care, costs of metastatic disease, and a computed tomography scan over a wide range did not affect the superiority of screening.CONCLUSIONS.The model found that urine‐based markers are cost‐effective in a high‐risk population. Prospective randomized trials in a completely asymptomatic high‐risk cohort are indicated before bladder cancer screening can be recommended. Cancer 2006. © 2006 American Cancer Society.

Cost‐effectiveness analysis of immediate radical cystectomy versus intravesical Bacillus Calmette‐Guerin therapy for high‐risk, high‐grade (T1G3) bladder cancer

“…These studies have evaluated the treatment of patients with transitional cell cancer, 39,40 analyzed options for screening for bladder cancer, 41,42 or quantified costs associated with bladder cancer follow-up and complications. 37,43,44 Although those results are not directly comparable with our analysis, these and other 45,46 studies reported cost estimates that were similar to the estimates in our model, suggesting that our single institution's cost estimates may be broadly applicable to other settings.…”

Biomarkers for detection and surveillance of bladder cancer

“…Such considerations are directly dependent on the incidence of the disease as well as on the sensitivity and specificity of the marker, in addition to the overall costs of each test. 7 Lotan and colleagues 6 reported that screening of all men aged 55 years or older was significantly more costly on a per-cancer basis than screening only in a highrisk group (more than US$400 000 v. $3130). Svatek and colleagues 7 suggest that marker screening of a high-risk group could be cost effective, although additional studies in an asymptomatic cohort are required before screening of a general population is recommended.…”

Systematic review of the clinical effectiveness and cost-effectiveness of photodynamic diagnosis and urine biomarkers (FISH, ImmunoCyt, NMP22) and cytology for the detection and follow-up of bladder cancer

“…Based on the care pathway described in Chapter 2, the model structure was developed following consultation with clinicians and taking into consideration the approaches adopted by the existing economic evaluations 153,158,[175][176][177][178][179][180] identified from the literature. The approach attempts to model patients passing through the whole sequence of care and determine the overall impact on costs and the clinical consequences.…”