title: Economic aspects of bladder cancer: what are the benefits and costs?
abstract: OBJECTIVE
  Bladder cancer (BC) has the highest lifetime treatment costs per patient of all cancers. The high recurrence rate and ongoing invasive monitoring requirement are the key contributors to the economic and human toll of this disease. The purpose of this paper was to utilize the recent literature to identify opportunities for improving the benefits and costs of BC care.
  
  
  METHODS
  A PubMed search was performed of recent publications concerning (BC) cost-effectiveness. We reviewed studies, reviews, opinion papers and cost-effectiveness analyses, focusing primarily on non-muscle-invasive bladder cancer (Ta/T1; NMIBC).
  
  
  RESULTS
  New diagnostic tools such as urine markers may assist in more cost-effectively detecting BC at an earlier stage, however, these markers cannot replace the cystoscopy, which is the current standard of care. A photodynamic diagnostic tool (PDD) using hexylaminolevulinate (Hexvix) enhances tumor visibility and improves transurethral resection of bladder cancer (TURB) results, potentially reducing recurrence rates and lowering treatment costs. While the importance of BC research has been acknowledged, research investment has been continuously reduced during the last 5 years.
  
  
  CONCLUSIONS
  The economic burden of BC is well-characterized in the literature. This study suggests that new technologies (i.e., urine-based tests, PDD) and therapeutic regimes (intravesical chemotherapy, adjuvant immunotherapy) have significant potential to improve the diagnosis, treatment and on-going monitoring of BC patients, with potential improvements in clinical outcomes and concurrent cost-savings. A renewed interest and investment in BC research are required to ensure future advancements.
authors.affiliation: Department for Urology, University of Tuebingen, Hoppe-Seyler-Str. 3, Tüebingen 72076, Germany. Karl.Sievert@med.uni-tuebingen.de
authors.forename: K D
authors.initials: KD
authors.lastname: Sievert
authors.forename: B
authors.initials: B
authors.lastname: Amend
authors.forename: U
authors.initials: U
authors.lastname: Nagele
authors.forename: D
authors.initials: D
authors.lastname: Schilling
authors.forename: J
authors.initials: J
authors.lastname: Bedke
authors.forename: M
authors.initials: M
authors.lastname: Horstmann
authors.forename: J
authors.initials: J
authors.lastname: Hennenlotter
authors.forename: S
authors.initials: S
authors.lastname: Kruck
authors.forename: A
authors.initials: A
authors.lastname: Stenzl
mesh_terms: D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D006801:Humans; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000628:therapy