Real-world data on the costs and outcomes of blue light cystoscopy (BLC) for non-muscle-invasive bladder cancer (NMIBC) are limited. We compared healthcare costs and oncologic outcomes associated with BLC versus white light cystoscopy only (WLC) in patients with NMIBC.
We performed a retrospective cohort study of NMIBC patients treated in the Veterans Affairs (VA) healthcare system between January 1, 1997 and December 31, 2021. Patients exposed to BLC after diagnosis were compared with WLC-only patients. Propensity score matching (1:1) identified 311 BLC-exposed and 311 WLC-only patients. Outcomes included 5-year total and category-specific healthcare costs, NMIBC recurrence, and recurrence-related cost offsets.
Among 622 matched patients (311 BLC; 311 WLC), median age was 71 years, and 378 (61%) had high-risk disease. BLC-exposed patients were more likely to receive intravesical BCG (190 [61%] vs. 133 [43%]; p < 0.01) and intravesical chemotherapy (149 [49%] vs. 86 [28%]; p < 0.01). Unadjusted 5-year total costs were higher with BLC ($108,411 vs. $66,734; p < 0.01), primarily due to outpatient costs ($90,788 vs. $55,529; p < 0.01). BLC was associated with decreased risk of recurrence (HR 0.62, 95% CI 0.45 - 0.86). After accounting for recurrence-related cost offsets, the adjusted 5-year cost difference was $721 per patient.
In an equal-access setting, BLC exposure was associated with higher 5-year costs, largely driven by outpatient care. However, lower recurrence rates reduced the net cost difference, resulting in near cost neutrality. These findings highlight the trade-off between higher upfront costs and improved recurrence outcomes when incorporating BLC into NMIBC management.
Urologic oncology. 2026 Apr 03 [Epub ahead of print]
Ali A Nasrallah, Claire Evans, Lin Gu, Joshua A Parrish, Amanda M De Hoedt, Jane Lapon, Chad McKee, William Aronson, Stephen J Freedland, Stephen B Williams
Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, TX., Department of Surgery, Durham Veterans Affairs Health Care System, Durham, NC., Department of Surgery, Durham Veterans Affairs Health Care System, Durham, NC; Duke Cancer Institute Biostatistics Shared Resource, Durham, NC., Medical Affairs, Photocure Inc, Princeton, NJ., Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA; Greater Los Angeles Veterans Affair, Los Angeles, CA; Department of Urology, University of California-Los Angeles, Los Angeles, CA., Department of Surgery, Durham Veterans Affairs Health Care System, Durham, NC; Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA., Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, TX. Electronic address: .