title: Cost-effectiveness of fluorescence in situ hybridization in patients with atypical cytology for the detection of urothelial carcinoma.
abstract: OBJECTIVE
  Patients with atypical cytology and equivocal or negative cystoscopy pose a challenge due to uncertainty about the presence of cancer. We determined the cost-effectiveness of using fluorescence in situ hybridization assays to determine the need for biopsy in patients with atypical cytology and equivocal or negative cystoscopy.
  
  
  METHODS
  Data from 2 large prospective studies evaluating the usefulness of fluorescence in situ hybridization in the setting of atypical cytology to detect urothelial carcinoma were combined. The data were used to calculate sensitivity and specificity for the UroVysion fluorescence in situ hybridization assay in various clinical scenarios. Cost data were obtained from our institution and Medicare reimbursement rates. Evaluations with or without bladder biopsy and with or without upper tract evaluation were considered.
  
  
  RESULTS
  The study included 263 patients with atypical cytology and equivocal (62) or negative (201) cystoscopy. In patients with equivocal cystoscopy (assuming biopsy was performed in the operating room) biopsy based on fluorescence in situ hybridization results saved $1,740 per patient ($3,267 vs $1,527 per patient) and avoided 42 biopsies compared to biopsy in all patients. If office based biopsies were used then cost savings using fluorescence in situ hybridization results were $95 per patient. Among patients with negative cystoscopy biopsy based on fluorescence in situ hybridization resulted in costs savings of $2,241 per patient, avoiding 167 biopsies, compared to biopsy in all patients. Assuming office based biopsy, the cost savings were $216 per patient.
  
  
  CONCLUSIONS
  The decision to perform biopsy based on fluorescence in situ hybridization assay in patients with atypical cytology and equivocal or negative cystoscopy was associated with a significant decrease in bladder cancer associated costs.
authors.affiliation: Department of Urology, UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Bishoy A
authors.initials: BA
authors.lastname: Gayed
authors.forename: Casey
authors.initials: C
authors.lastname: Seideman
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
mesh_terms: D001706:Biopsy; D002295:Carcinoma, Transitional Cell / Q000191:economics* / Q000473:pathology*; D003362:Cost-Benefit Analysis; D003558:Cystoscopy; D003663:Decision Trees; D006801:Humans; D017404:In Situ Hybridization, Fluorescence / Q000191:economics*; D011446:Prospective Studies; D001749:Urinary Bladder Neoplasms / Q000191:economics* / Q000473:pathology*
keywords: CIS; CT; FISH; OR; UC; UTUC; biological; carcinoma in situ; computerized tomography; cost-benefit analysis; fluorescence; fluorescence in situ hybridization; in situ hybridization; operating room; tumor markers; upper tract urothelial cancer; urinary bladder neoplasms; urothelial cancer; watchful waiting