PMID- 21426474
OWN - NLM
STAT- MEDLINE
DCOM- 20111108
LR  - 20220316
IS  - 1464-410X (Electronic)
IS  - 1464-4096 (Linking)
VI  - 108
IP  - 7
DP  - 2011 Oct
TI  - Prospective trial to identify optimal bladder cancer surveillance protocol: 
      reducing costs while maximizing sensitivity.
PG  - 1119-23
LID - 10.1111/j.1464-410X.2010.10026.x [doi]
AB  - OBJECTIVE: * To assess the cost-effectiveness of using cytological evaluation, 
      NMP22 BladderChek(R), and fluorescence in situ hybridization (FISH) UroVysion(R) in 
      addition to cystoscopy in patients with a history of bladder cancer undergoing 
      surveillance for recurrence. PATIENTS AND METHODS: * In all, 200 consecutive 
      patients with a history of bladder cancer not invading the muscle were 
      prospectively enrolled at The University of Texas MD Anderson Cancer Center. * 
      Five surveillance strategies were compared: (i) cystoscopy alone; (ii) cystoscopy 
      and NMP22; (iii) cystoscopy and FISH; (iv) cystoscopy and cytology; and (v) 
      cystoscopy and positive NMP22 confirmed by positive FISH. * The cost per cancer 
      detected was calculated. * For patients with an initial positive test and 
      negative cystoscopy, tumour detected at first follow-up was assumed to be too 
      small to be visualized at the initial assessment and the biomarker was credited 
      with early detection. RESULTS: * Cancer was detected in 13 patients at study 
      entry. * Detection rates for the five surveillance strategies were: (i) 52%, (ii) 
      56%, (iii) 72%, (iv) 60%, and (v) 56%. * The costs per tumour detected (at the 
      time of initial marker analysis) were (i) $7692; (ii) $12,000; (iii) $26,462; 
      (iv) $11,846; and (v) $10,292. * When early detection of biomarkers was factored 
      in, the CPTD became: (i) $7692; (ii) $11,143; (iii) $19,111; (iv) $10,267; and 
      (v) $9557. * There were 12 new cancers detected at first follow-up (median time, 
      4.1 months). None of the tumours detected by biomarkers but not by cystoscopy 
      were invasive. CONCLUSIONS: * Cystoscopy alone remains the most cost-effective 
      strategy to detect recurrence of bladder cancer not invading the muscle. * The 
      addition of urinary markers adds to cost, without improved detection of invasive 
      disease.
CI  - (c) 2011 THE AUTHORS. BJU INTERNATIONAL (c) 2011 BJU INTERNATIONAL.
FAU - Kamat, Ashish M
AU  - Kamat AM
AD  - Department of Urology, The University of Texas MD Anderson Cancer Center, 
      Houston, TX 77030, USA. akamat@mdanderson.org
FAU - Karam, Jose A
AU  - Karam JA
FAU - Grossman, H Barton
AU  - Grossman HB
FAU - Kader, A Karim
AU  - Kader AK
FAU - Munsell, Mark
AU  - Munsell M
FAU - Dinney, Colin P
AU  - Dinney CP
LA  - eng
GR  - P50-CA91846-01/CA/NCI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20110322
PL  - England
TA  - BJU Int
JT  - BJU international
JID - 100886721
SB  - IM
CIN - BJU Int. 2011 Oct;108(7):1123-4. PMID: 21545386
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Clinical Protocols
MH  - Cost-Benefit Analysis
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Neoplasm Recurrence, Local/*diagnosis/*economics
MH  - Population Surveillance
MH  - Prospective Studies
MH  - Urinary Bladder Neoplasms/*diagnosis/*economics
MH  - Young Adult
EDAT- 2011/03/24 06:00
MHDA- 2011/11/09 06:00
CRDT- 2011/03/24 06:00
PHST- 2011/03/24 06:00 [entrez]
PHST- 2011/03/24 06:00 [pubmed]
PHST- 2011/11/09 06:00 [medline]
AID - 10.1111/j.1464-410X.2010.10026.x [doi]
PST - ppublish
SO  - BJU Int. 2011 Oct;108(7):1119-23. doi: 10.1111/j.1464-410X.2010.10026.x. Epub 
      2011 Mar 22.