There is a void in comparative research justifying the use of BLC in the office setting. We sought to determine the estimated budget impact to practices incorporating BLC with hexaminolevulinate HCl (HAL) for the surveillance of non-muscle-invasive bladder cancer (NMIBC) in the clinic setting.
A budget impact model was developed from an academic medical system hospital outpatient department perspective to assess the projected costs and reimbursement at 2 years for a simulated facility with 50 newly diagnosed patients who were undergoing cystoscopy for the detection of NMIBC, including carcinoma in situ (CIS), among patients suspected or known to have lesion(s). The population of interest was quantified using published data on bladder cancer epidemiology, including the incidence of newly diagnosed bladder cancer cases, the percent of those tumors that are NMIBC, and the stage and grade of tumor.
At 2 years of follow-up, the use of BLC identified 9 additional recurrences compared to WLC alone. Of those recurrences missed in the first year using WLC alone, approximately 1% would progress to a higher tumor grade, resulting in higher costs for detection and treatment. Institutions that adopted WL + BL cystoscopy in both practice settings would see a ~ $1 increase in reimbursement than institutions that have WL cystoscopy alone.
The current study suggests that the use of flexible BLC for the surveillance of NMIBC may result in a modest increase in cost per cystoscopy. However, our findings must be interpreted within the context of the study design as the model was based on retrospective data with several assumptions. Further studies investigating the economic impact on bladder cancer care are needed to mitigate rising costs and guide clinical practice guidelines that promote cost-effective care with improved patient outcomes.
Written by: Stephen B. Williams, MD, MS, FACS, Medical Director for High Value Care, UTMB Health System, Chief, Division of Urology, Professor (Tenured), Urology and Radiology, The Robert Earl Cone, Professorship, Director of Urologic Oncology, Director of Urologic Research, Co-Director, UTMB Surgical Outcomes Research Program, Galveston, TX
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