title: The cost-effectiveness of blue light cystoscopy in bladder cancer detection: United States projections based on clinical data showing 4.5 years of follow up after a single hexaminolevulinate hydrochloride instillation.
abstract: BACKGROUND
  Several studies, including the recently published phase III study by Stenzl and colleagues have demonstrated that hexaminolevulinate hydrochloride, when used with blue light fluorescence cystoscopy, improves detection of non-muscle invasive bladder tumors compared to white light cystoscopy and transurethral resection of bladder tumors (TURB) alone.
  
  
  METHODS
  The objective of this study was to conduct a detailed assessment of the cost-effectiveness of using hexaminolevulinate hydrochloride with blue light cystoscopy as an adjunct to white light versus white light cystoscopy alone at time of initial TURB in the United States. A probabilistic decision tree model, using TreeAge Pro 2011 software, was developed using base case scenario cost and utility estimates.
  
  
  RESULTS
  Incorporation of hexaminolevulinate hydrochloride into diagnostic cystoscopy results in lower costs over 5 years ($25,921) as compared to those patients who initially receive white light cystoscopy ($30,581). Those patients who initially receive hexaminolevulinate hydrochloride blue light TURB also experience a lower overall cancer burden.
  
  
  CONCLUSIONS
  Hexaminolevulinate hydrochloride may be cost effective when used at first TURB for patients with suspected new or recurrent non-muscle invasive bladder cancer.
authors.affiliation: GfK Bridgehead, Wayland, Massachusetts, USA.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Garfield
authors.forename: Meghan B
authors.initials: MB
authors.lastname: Gavaghan
authors.forename: Shannon O
authors.initials: SO
authors.lastname: Armstrong
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Jones
mesh_terms: D000368:Aged; D000622:Aminolevulinic Acid / Q000031:analogs & derivatives*; D003362:Cost-Benefit Analysis; D003558:Cystoscopy / Q000191:economics* / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012984:Software; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery
chemical_list: D000622:Aminolevulinic Acid; C419924:5-aminolevulinic acid hexyl ester