Cystoscopy without the aid of urinary markers is the most cost-effective strategy for detecting recurrence of non-invasive bladder cancer, according to researchers.

In a study that examined five surveillance strategies among 200 patients with a history of bladder cancer not invading the muscle, cystoscopy alone was the most inexpensive, with a detection rate of 52% at $7,692 per cancer detected and a $100,000 overall cost.

In the study, all patients underwent cystoscopy. The researchers compared cystoscopy alone with cystoscopy plus NMP22, an antibody-based test used to detect a nuclear matrix protein; cystoscopy plus fluorescence in situ hybridization (FISH), which is used to detect tumors before they are cystoscopically evident; cystoscopy plus NMP22 and then FISH; and cystoscopy plus cytology.

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Cystoscopy plus NMP22 had a 56% detection rate at a cost of $12,000 per cancer detected. Cystoscopy plus FISH had a 72% detection rate at a cost of $26,462 per cancer detected. Cystoscopy plus NMP22 and FISH had a detection rate of 56% at a cost of $10,292 per cancer detected. Cystoscopy with cytological evaluation had a 60% detection rate at a cost of $11,846 per cancer detected. All surveillance methods missed two invasive tumors.

Ashish M. Kamat, MD, of the University of Texas MD Anderson Cancer Center in Houston, and colleagues published their findings in the BJU International (2011;108:1119-1123). To their knowledge, the authors said that this is the first clinical trial to evaluate the cost-effectiveness of bladder cancer surveillance strategies.

Even if tests are inexpensive, the researchers said, they can lead to overall increases in cost with “unnecessary, expensive, invasive and potentially morbid procedures.” While methods such as NMP22 may improve detection, none of them are considerably cost-effective especially considering the non-invasive nature of all detected tumors.