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
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“…12 Several other features of bladder cancer have been described in the secondary care literature, including lower urinary tract symptoms, abdominal pain, and masses. 2,13 The aim of this study was to identify the symptoms of bladder cancer in primary care, and to quantify them, both singly and in pairs. This should allow improved selection of patients for investigation, reducing the human and economic cost of this disease.…”
Section: Resultsmentioning
confidence: 99%
“…1 It is strongly associated with cigarette smoking, and is approximately 2.5 times more common in males. 2 The incidence rises with age, with the average age at diagnosis being 71 years. 2 At the time of diagnosis in the UK, approximately 75-85% patients have a non-invasive tumour, with a recurrence rate of 31-78%, yet with high 5-year survival of 80-90%.…”
Section: Introductionmentioning
confidence: 99%
“…2 The incidence rises with age, with the average age at diagnosis being 71 years. 2 At the time of diagnosis in the UK, approximately 75-85% patients have a non-invasive tumour, with a recurrence rate of 31-78%, yet with high 5-year survival of 80-90%. Around 30% are multifocal.…”
Section: Introductionmentioning
confidence: 99%
“…In contrast, once the tumour has invaded muscle, survival is below 50%. 2 Emergency presentations occur predominately with advanced disease and have a higher mortality. 3 More timely diagnosis of bladder cancer may improve outcomes, either by a favourable stage shift or by avoiding emergency presentations.…”
BackgroundBladder cancer accounts for over 150 000 deaths worldwide. No screening is available, so diagnosis depends on investigations of symptoms. Of these, only visible haematuria has been studied in primary care.
AimTo identify and quantify the features of bladder cancer in primary care.
Design and settingCase-control study, using electronic medical records from UK primary care.
“…12 Several other features of bladder cancer have been described in the secondary care literature, including lower urinary tract symptoms, abdominal pain, and masses. 2,13 The aim of this study was to identify the symptoms of bladder cancer in primary care, and to quantify them, both singly and in pairs. This should allow improved selection of patients for investigation, reducing the human and economic cost of this disease.…”
Section: Resultsmentioning
confidence: 99%
“…1 It is strongly associated with cigarette smoking, and is approximately 2.5 times more common in males. 2 The incidence rises with age, with the average age at diagnosis being 71 years. 2 At the time of diagnosis in the UK, approximately 75-85% patients have a non-invasive tumour, with a recurrence rate of 31-78%, yet with high 5-year survival of 80-90%.…”
Section: Introductionmentioning
confidence: 99%
“…2 The incidence rises with age, with the average age at diagnosis being 71 years. 2 At the time of diagnosis in the UK, approximately 75-85% patients have a non-invasive tumour, with a recurrence rate of 31-78%, yet with high 5-year survival of 80-90%. Around 30% are multifocal.…”
Section: Introductionmentioning
confidence: 99%
“…In contrast, once the tumour has invaded muscle, survival is below 50%. 2 Emergency presentations occur predominately with advanced disease and have a higher mortality. 3 More timely diagnosis of bladder cancer may improve outcomes, either by a favourable stage shift or by avoiding emergency presentations.…”
BackgroundBladder cancer accounts for over 150 000 deaths worldwide. No screening is available, so diagnosis depends on investigations of symptoms. Of these, only visible haematuria has been studied in primary care.
AimTo identify and quantify the features of bladder cancer in primary care.
Design and settingCase-control study, using electronic medical records from UK primary care.
“…Over the previous decade, several studies have evaluated the diagnostic value of FISH in UC, but the clinical value and cost-efficiency remains incompletely characterized (17,18). As important data has arisen from case-control designs (19)(20)(21) or focused on BUC or UTUC exclusively (22)(23)(24)(25), the present study was designed to assess the diagnostic value of FISH for detecting UC prospectively, and to evaluate the utility of FISH in association with cytology as a non-invasive diagnostic technique.…”
Abstract. Urothelial carcinoma (UC) is the most common type of cancer of the bladder and upper urinary tract, and is characterized by a high risk of recurrence and progression. Urine fluorescence in situ hybridization (FISH) is a technique that detects genetic aberrations in exfoliated cells in the urine, with specific probes for chromosomes 3, 7 and 17 and the p16 gene. To evaluate the diagnostic value of FISH in UC, 119 patients from November 2010 to June 2012 with suspected UC were recruited into a prospective, cross-sectional study and were followed up for 12-30 months. These patients received voided urine cytology and FISH tests, and underwent cystoscopy and/or ureteroscopy as a reference standard. The final diagnoses confirmed 73 patients with UC, located in the bladder, upper urinary tracts or the two. The sensitivity of FISH for detecting UC was superior to cytology, irrespective of tumor grade and stage: Overall, 80.8 vs. 32.9% (P<0.001); low grade, 75.8 vs. 12.1% (P<0.001); high grade, 85 vs. 50% (P<0.005); non-muscle-invasive, 81.1 vs. 28.3% (P<0.001) and muscle-invasive, 80 vs. 45% (P<0.05), respectively. The specificities of the two tests were similar; overall, the specificity was 89.1% for cytology vs. 100% for FISH, and no significant difference was observed between the methods. Notably, FISH exhibited 100% sensitivity for cytologically non-diagnostic UC, but 33.3% specificity. In conclusion, FISH is a reliable and non-invasive diagnostic tool for bladder and upper urinary tract UC, particularly in patients with low-grade or early stage
IMPORTANCE Asymptomatic microscopic hematuria (AMH) is highly prevalent and may signal occult genitourinary (GU) malignant abnormality. Common diagnostic approaches differ in their costs and effectiveness in detecting cancer. Given the low prevalence of GU malignant abnormality among patients with AMH, it is important to quantify the cost implications of detecting cancer for each approach. OBJECTIVE To estimate the effectiveness, costs, and incremental cost per cancer detected (ICCD) for 4 common diagnostic approaches evaluating AMH. DESIGN, SETTING, AND PARTICIPANTS A decision-analytic model-based cost-effectiveness analysis using inputs from the medical literature. PubMed searches were performed to identify relevant literature for all key model inputs, each of which was derived from the clinical study with the most robust data and greatest applicability. Analysis included adult patients with AMH on routine urinalysis with subgroups of high-risk patients (males, smokers, age Ն50 years) seen in the primary care or urologic referral setting. INTERVENTIONS Four diagnostic approaches were evaluated relative to the reference case of no evaluation: (1) computed tomography (CT) alone; (2) cystoscopy alone; (3) CT and cystoscopy combined; and (4) renal ultrasound and cystoscopy combined. MAIN OUTCOMES AND MEASURES At termination of the diagnostic period, cancers detected, costs (payer perspective), and ICCD per 10 000 patients evaluated for AMH. RESULTS Of the 4 diagnostic approaches analyzed, CT alone was dominated by all other strategies, detecting 221 cancers at a cost of $9 300 000. Ultrasound and cystoscopy detected 245 cancers and was most cost-effective with an ICCD of $53 810. Replacing ultrasound with CT detected just 1 additional cancer at an ICCD of $6 480 484. Ultrasound and cystoscopy remained the most cost-effective approach in subgroup analysis. The model was not sensitive to any inputs within the proposed ranges. Using probabilistic sensitivity analysis, ultrasound and cystoscopy was the dominant strategy in 100% of simulations. CONCLUSIONS AND RELEVANCE The combination of renal ultrasound and cystoscopy is the most cost-effective among 4 diagnostic approaches for the initial evaluation of AMH. The use of ultrasound in lieu of CT as the first-line diagnostic strategy will optimize cancer detection and reduce costs associated with evaluation of AMH. Given our findings, we need to critically evaluate the appropriateness of our current clinical practices, and potentially alter our guidelines to reflect the most effective screening strategies for patients with AMH.
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