ASCO: Cystoscopy Alone More Cost-Effective in Surveillance

Cystoscopy with urinary biomarkers ups cost, false positives, but not recurrence detection rates

THURSDAY, March 4 (HealthDay News) -- Follow up screening for non-muscle-invasive bladder cancer (NMIBC) recurrence with only cystoscopy is more cost-effective than combined cystoscopy with urinary biomarker detection, and is associated with a lower incidence of false-positive results, according to research presented at the 2010 Genitourinary Cancers Symposium, held from March 5 to 7 in San Francisco.

In 200 patients with a history of bladder cancer, Jose Karam, M.D., of the University of Texas M.D. Anderson Cancer Center in Houston, and colleagues used 2009 Medicare reimbursement data to evaluate the cost per cancer detected of common bladder cancer surveillance strategies, including cystoscopy alone and cystoscopy in combination with NMP22, FISH, cytology, and NMP22 plus FISH to confirm abnormal NMP22.

The researchers found that cystoscopy alone provided the lowest cost per tumor detected ($7,692), followed by cystoscopy with NMP22 confirmed by FISH ($9,557), cystoscopy plus cytology ($10,267), cystoscopy plus NMP22 ($11,143), and cystoscopy plus FISH ($19,111). Cystoscopy alone was associated with only two false-positives, while cystoscopy plus FISH was associated with 30 false-positives.

"Based on our prospective study, cystoscopy alone remains the most cost-effective strategy to detect recurrence of NMIBC and results in least number of cancers missed. The addition of urinary markers adds to cost, without increase in tumor detection," the authors conclude.

One author reported receiving research funding from Abbott Diagnostics and Genomic Health, while another author reported receiving consulting fees from multiple pharmaceutical and diagnostic companies.

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