Introduction:

Bladder cancer is the sixth-most prevalent cancer in the United States, and is associated with high treatment and lifetime costs. A significant portion of cost is related to the high rates of cancer recurrence. Blue light cystoscopy (BLC) is utilized in non-muscle invasive bladder cancer (NMIBC) for better and earlier detection of tumors. BLC use has also been associated with reduced risk of cancer recurrence. The purpose of this study was to compare the healthcare costs and oncologic outcomes associated with blue light cystoscopy exposure (BLC) versus white light cystoscopy only (WLC) in NMIBC.

Methods:

Patients diagnosed with NMIBC between 1997 and 2021 and exposed to BLC versus WLC-only in the Veterans Affairs (VA) healthcare system were identified. Propensity-score matching accounting for demographic and clinical variables was used. The primary objective was to determine the difference in total healthcare costs over 1, 2, and 5-year intervals in line with oncologic outcomes. A cost-offset analysis was performed addressing multiple aspects of BLC healthcare costs including the financial impacts of recurrence avoidance.

Results:

Among 622 matched patients with available cost data (311 BLC and 311 WLC), median age was 71 years, 98% were male, and 10% were African American. The study population was predominantly high-risk NMIBC (61%). BLC patients were more likely to receive intravesical BCG (61 vs 43%; p<0.01) and intravesical chemotherapy (49% and 28%, p<0.01). BLC use was associated with decreased risk of recurrence (HR 0.62, 95% CI 0.45 – 0.86), and a NNT of 10. Initial total costs over 5-years were higher in the BLC group ($108,411 vs $66,734; p<0.01), with outpatient costs being the main driver ($90,788 vs $55,529; p<0.01). However, given the lower recurrence rates with BLC and the additional costs related to management of recurrence, a cost-offset analysis showed that the 5-year costs of BLC exposure were $604 more per person versus WLC.

Conclusion:

In a real-world equal-access setting, initial 5-year total costs for BLC were higher, mostly driven by outpatient costs likely related to increased utilization of intravesical therapies and closer surveillance in BLC patients. However, given the lower recurrence rates with BLC and accounting for the costs of treating recurrence, the adjusted cost difference approaches net neutral.

Funding: This work was supported by Photocure, Inc