Should we screen for bladder cancer in a high-risk population? A cost per life-year saved analysis

Yair Lotan, Robert S. Svatek, Arthur I Sagalowsky

Research output: Contribution to journalReview article

96 Scopus citations

Abstract

BACKGROUND. The U.S. Food and Drug Administration recently approved screening high-risk patients for bladder cancer using urine-based markers. The cost and life-years saved associated with bladder cancer screening were evaluated. METHODS. A Markov model was created to estimate cumulative cancer-related costs and efficacy of screening (vs. no screening) of a high-risk population for bladder cancer using a urine-based tumor marker over a 5-year period. Assumptions were based on literature review of survival and progression rates for patients with bladder cancer and costs associated with different bladder cancer disease states. RESULTS. Screening for bladder cancer in a population with a 4% incidence of bladder cancer resulted in a gain of 3.0 life years per 1000 subjects at a cost savings of $101,000 for the population, assuming a 50% downstaging in the screened population from muscle-invasive to nonmuscle-invasive disease. One-way sensitivity analyses found that screening is the most cost-effective strategy if cancer incidence is >1.6%, tumor marker costs <$126, marker sensitivity is >26%, marker specificity is >54%, downstaging with screening is >20%, and office cystoscopy costs <$694. Varying costs of cystectomy, transurethral resection of bladder tumor (TURBT), chemotherapy, end-of-life care, costs of metastatic disease, and a computed tomography scan over a wide range did not affect the superiority of screening. CONCLUSIONS. The model found that urine-based markers are cost-effective in a high-risk population. Prospective randomized trials in a completely asymptomatic high-risk cohort are indicated before bladder cancer screening can be recommended.

Original languageEnglish (US)
Pages (from-to)982-990
Number of pages9
JournalCancer
Volume107
Issue number5
DOIs
StatePublished - Sep 1 2006

Keywords

  • Bladder cancer
  • Cost
  • Life-years saved
  • NMP22
  • Screening
  • Urine biomarker

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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