The economics of bladder cancer: costs and considerations of caring for this disease.
BACKGROUND
Due to high recurrence rates, intensive surveillance strategies, and expensive treatment costs, the management of bladder cancer contributes significantly to medical costs.


OBJECTIVE
To provide a concise evaluation of contemporary cost-related challenges in the care of patients with bladder cancer. An emphasis is placed on the initial diagnosis of bladder cancer and therapy considerations for both non-muscle-invasive bladder cancer (NMIBC) and more advanced disease.


METHODS
A systematic review of the literature was performed using Medline (1966 to February 2011). Medical Subject Headings (MeSH) terms for search criteria included "bladder cancer, neoplasms" OR "carcinoma, transitional cell" AND all cost-related MeSH search terms. Studies evaluating the costs associated with of various diagnostic or treatment approaches were reviewed.


RESULTS
Routine use of perioperative chemotherapy following complete transurethral resection of bladder tumor has been estimated to provide a cost savings. Routine office-based fulguration of small low-grade recurrences could decrease costs. Another potential important target for decreasing variation and cost lies in risk-modified surveillance strategies after initial bladder tumor removal to reduce the cost associated with frequent cystoscopic and radiographic procedures. Optimizing postoperative care after radical cystectomy has the potential to decrease length of stay and perioperative morbidity with substantial decreases in perioperative care expenses. The gemcitabine-cisplatin regimen has been estimated to result in a modest increase in cost effectiveness over methotrexate, vinblastine, doxorubicin, and cisplatin. Additional costs of therapies need to be balanced with effectiveness, and there are significant gaps in knowledge regarding optimal surveillance and treatment of both early and advanced bladder cancer.


CONCLUSIONS
Regardless of disease severity, improvements in the efficiency of bladder cancer care to limit unnecessary interventions and optimize effective cancer treatment can reduce overall health care costs. Two scenarios where economic and comparative-effectiveness research is limited but would be most beneficial are (1) the management of NMIBC patients where excessive costs are due to vigilant surveillance strategies and (2) in patients with metastatic disease due to the enormous cost associated with late-stage and end-of-life care.
Department of Urology, Division of Urologic Oncology, The University of Texas Health Science Center San Antonio, San Antonio, TX, USA.
Robert S
RS
Svatek
Department of Urology, Division of Health Services Research and Division of Urologic Oncology, University of Michigan, Ann Arbor, MI, USA.
Brent K
BK
Hollenbeck
Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Sten
S
Holmäng
Department of Urology and Division of Medical Oncology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
Richard
R
Lee
Department of Urology, Yale University, New Haven, CT, USA.
Simon P
SP
Kim
Department of Urology, Klinik für Urologie, Tübingen, Germany.
Arnulf
A
Stenzl
Department of Urology, University of Texas Southwestern, Dallas, TX, USA. Electronic address: yair.lotan@utsouthwestern.edu.
Yair
Y
Lotan
D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D003131:Combined Modality Therapy / Q000191:economics; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D015653:Cystectomy / Q000191:economics; D003952:Diagnostic Imaging / Q000191:economics; D003950:Diagnostic Techniques, Urological / Q000191:economics; D005249:Fees and Charges; D017048:Health Care Costs; D006801:Humans; D019990:Perioperative Care / Q000191:economics; D011159:Population Surveillance; D011878:Radiotherapy / Q000191:economics; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000628:therapy
D000970:Antineoplastic Agents
Bladder cancer; Charge; Cost; Cost effectiveness