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Abstract
Aims
French guidelines for the management of non-muscle-invasive bladder cancer recommend that blue-light cystoscopy should be used in patients where the risk of missing residual tumor is highest. Despite evidence for its cost-effectiveness, budgetary concerns have limited uptake in France. The aim of this analysis was to model the cost-consequences of adopting the recommendations in a French urology unit.
Materials and methods
A budget impact model was developed in Excel, using a decision tree approach derived from guidelines issued by L’Academie franҫaise d’urologie. Risk profiles were derived from an analysis of studies using white-light cystoscopy; estimates for the impact of blue-light cystoscopy were derived from a published Cochrane Review. Costs were based on published tariff prices from L’Agence Technique de L’Information sur L’Hospitalisation. The model allowed results to be tailored to activity levels and projected blue-light usage in the chosen urology unit.
Results
Two scenarios were evaluated, based on a 3-year time horizon. Full implementation of all recommendations within a large public hospital was estimated to yield incremental costs of €269 per procedure (∼10% increase overall); a more targeted approach within a smaller private hospital yielded incremental costs of €133 per procedure (5% increase overall).
Limitations
The basis of the model is a change in the time to first recurrence. There are no data available for subsequent recurrences or progression, both of which could have an influence on expenditure. Secondly, recurrence rates for blue-light cystoscopy were not specifically available for each patient group identified in the guidelines: extrapolation of data may have resulted in bias. Finally, the data were derived from clinical trials, which may not be generalisable to real-world clinical practice.
Conclusions
The model has shown that the additional expenditure required to implement blue-light cystoscopy is modest and not disproportionate to the overall cost of care.
Transparency
Declaration of funding
The article received funding from Photocure GmbH.
Declaration of financial/other relationships
JB Medical Ltd is a market access consultancy and receives funding from the medical device and pharmaceutical industry to provide support and advice in gaining market access. JB Medical has received funding from Photocure for this project and similar projects across Europe.
Acknowledgements
None stated.
Reviewer disclosures
A reviewer on this manuscript has disclosed that they are a consultant and on the advisory board for Photocure. The other peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.