Photodynamic diagnostics and noninvasive bladder cancer: Is it cost-effective in long-term application? A Germany-based cost analysis

Objectives: Noninvasive urothelial carcinoma of the bladder (UCB) causes an enormous economic burden to public health systems due to its life-long character and frequent recurrences. While white light (WL) cystoscopy is considered to be the gold standard for transurethral resection of the bladder, photodynamic diagnostic (PDD) has been shown to improve final outcome. Escalating healthcare costs warrant increased effectiveness in treating noninvasive UCB. No data based on assessment of costs have been published to date. Methods: A series of 301 patients with noninvasive UCB were randomized prospectively to standard WL or PDD transurethral resections of the bladder. Intravesical adjuvant therapy was administered as reflected in the appropriate guidelines. Expenditures of subsequent procedures and PDD-associated costs were assessed. Results: Median follow-up was 7.1 yr. Disease recurrence was found in 42% and 18% of WL and PDD patients, respectively (p = 0.0003). In the WL group 2.0 and in the PDD group 0.8 transurethral resections of the bladder were noted per patient. In the WL group 1.0 and in the PDD group 0.3 recurring UCB occurred per patient, resulting in costs of C1750 per WL patient versuse420 per PDD patient in the follow-up period, respectively. Because a single expenditure of E135 was assessed for PDD, overall costs were significantly lower (by C1195) in PDD patients. As the median followup was 7.1 yr, costs saved by PDD per patient per year were E168. Conclusion: Our data suggest that PDD significantly cut costs related to recurring UCB. Further studies are needed from an economic point of view. (c) 2007 European Association of Urology, Published by Elsevier B.V. All rights reserved.