San Francisco, CA—A new study challenges the notion that more testing leads to greater accuracy in detection of non–muscle-invasive bladder cancer (NMIBC).
Results presented at the ASCO 2010 Genitourinary Cancers Symposium indicate that cystoscopy alone costs $7692 per tumor detected and has a low false-positive rate. Adding cytology, nuclear matrix protein 22 (NMP22), fluorescence in situ hybridization (FISH), or NMP22 plus FISH increases the cost significantly without a concomitant improvement in accuracy.
Ashish Kamat, MD, associate professor of Urology and director of the Urologic Oncology Fellowship Program, M. D. Anderson Cancer Center, Houston, Tx, and his colleagues conducted a study of 200 NMIBC patients.
At enrollment, the subjects underwent cystoscopy along with each of the above-mentioned tests. The investigators detected cancer in 13 patients at enrollment and another 12 at follow-up within 6 months.
The cost per tumor detected was $7692 for cystoscopy alone, $11100 for cystoscopy plus NMP22 BladderChek, $19111 for cystoscopy plus FISH Urovysion testing, $10300 for cystoscopy plus cystology, and $9600 for cystoscopy plus NMP22 followed by selective FISH use.
Taking into account the tumors detected at first follow-up, and assuming that the markers detected tumors prior to clinical visibility, the tumor detection rate for each strategy was 52%, 56%, 72%, 60%, and 56%, respectively.
“It is important to note that even though the markers could improve detection of tumors, the costs associated with the markers as well as the extra invasive procedures required for false-positive tests did not improve detection of invasive tumors,” Dr Kamat told Value-Based Cancer Care, in an interview conducted after the conference.
