The study authors Neal Shore**, MD, FACS and Meghan B. Gavaghan, MPH, built a budget impact model to assess projected ASC costs for a cohort of newly diagnosed bladder cancer patients over a 2-year follow-up comparing white light cystoscopy (WLC) alone versus WLC + blue light cystoscopy (BLC®). Treatment and surveillance intervals were based on AUA/SUO clinical guidelines. Clinical and cost metrics for staging and biopsy rates were assessed, with cost inputs based on Medicare reimbursement rates. Photocure supported this research with an unrestricted grant.
In the U.S., BLC for NMIBC surveillance in the ASC setting involves a flexible cystoscopy, an outpatient procedure without need of general anesthesia, allowing additional OR time for other hospital procedures. In the published clinical and health economic model, use of BLC resulted in the identification of 5 additional NMIBC recurrences compared to white light cystoscopy alone. There was an associated increased cost of performing BLC in an ASC setting, with a net increase in the total cost of care for NMIBC of $110 per cystoscopy over a two-year period. If recurrences missed using WLC alone were to progress prior to detection, the model projects an increase in treatment costs borne by Medicare of $9,097-$34,538 due to more intensive treatments required for more advanced disease.
The authors conclude that due to the modeled results, “the Medicare program will incur increased costs. … The current discrepancy in reimbursement disincentivizing community-based ASCs from adopting BLC, resulting in suboptimal patient care while increasing downstream treatment costs to Medicare, necessitated when missed disease progresses to higher stage/grade disease. The findings have important clinical implications for the optimal management of NMIBC and should inform healthcare policies that promote cost-effectiveness and enhanced patient outcomes.”
“The findings of this paper highlight the benefits of BLC when patients receive this option for bladder cancer care in ambulatory surgery centers,” said Dan Schneider, President and Chief Executive Officer of Photocure ASA. “The paper also reinforces the need for fair and equitable reimbursement in all sites of care, with Medicare payment rates increasing in January 2023, but favoring use of blue light in hospital outpatient departments (HOPDs) over ASCs. While we are pleased with the historic step by CMS to provide higher payment rates in both settings, feedback from ASC accounts is that payment would need to be increased further before patients treated in this site of care will be offered broad access to BLC. As a result, Photocure will continue to partner with the medical community to advocate for improved Medicare coverage in the ASC setting.”Source: Photocure. The Bladder Cancer Company. Accessed February 2, 2023. https://uat.photocure.com/newsletters/news-from-photocure-4436882.
Clinical and economic impact of blue light cystoscopy in the management of NMIBC at US ambulatory surgical centers: what is the site-of-service disparity?