Treatment of nonmuscle invading bladder cancer: do physicians in the United States practice evidence based medicine? The use and economic implications of intravesical chemotherapy after transurethral resection of bladder tumors.
BACKGROUND
Phase 3 clinical trials performed primarily outside the US demonstrate that intravesical instillation of chemotherapy immediately after transurethral resection of the bladder (TURB) decreases cancer recurrence rates. The authors sought to determine whether US urologists have adopted this practice, and its potential effect on costs of bladder cancer (BC) care.


METHODS
By using 1997-2004 MEDSTAT claims data, the authors identified patients with newly diagnosed BC who underwent cystoscopic biopsy or TURB, and those who received intravesical chemotherapy within 1 day after TURB. Economic consequences of this treatment compared with TURB alone were modeled using published efficacy estimates and Medicare reimbursements. The authors used a time horizon of 3 years and assumed that this treatment was given for all newly diagnosed low-risk BC patients.


RESULTS
Between 1997 and 2004, the authors identified 16,748 patients with newly diagnosed BC, of whom 14,677 underwent cystoscopic biopsy or TURB. Of these, only 49 (0.33%) received same-day intravesical instillation of chemotherapy. From 1997 through 2004, there has been little change in the use of this treatment. The authors estimated a 3-year savings of $538 to $690 (10% to 12%) per patient treated with TURB and immediate intravesical chemotherapy compared with TURB alone, reflecting a yearly national savings of $19.8 to $24.8 million.


CONCLUSIONS
Instillation of intravesical chemotherapy immediately after TURB has not been embraced in the US. Adopting this policy would significantly lower the cost of BC care.
Madeb
Ralph
R
Department of Urology, University of Rochester School of Medicine, Rochester, New York, USA.
Golijanin
Dragan
D
Noyes
Katia
K
Fisher
Susan
S
Stephenson
Judith J
JJ
Long
Stacey R
SR
Knopf
Joy
J
Lyman
Gary H
GH
Messing
Edward M
EM
D000283:Administration, Intravesical; D000465:Algorithms; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000191:economics*; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data*; D003131:Combined Modality Therapy; D019317:Evidence-Based Medicine; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000639:trends; D016032:Randomized Controlled Trials as Topic; D014481:United States; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology / Q000601:surgery
D000970:Antineoplastic Agents