title: [Cost-effectiveness of transurethral resection of the bladder with blue light in patients with non muscle invasive bladder cancer in France].
abstract: OBJECTIVE
  Photodynamic diagnosis after instillation of hexylaminolevulinate (Hexvix(®)) during transurethral resection of the bladder (TURB) helps in the detection of tumors and results in a reduction of recurrence. The medical and economic impact of fluorescence compared to conventional white light TURB needed to be analyzed in the French healthcare system. The aim of this study was to evaluate the medical and economic impact of the blue light TURB in the treatment of NMIBC.
  
  
  METHODS
  A cost-utility model, based on data from the literature and expert opinions, combining a decision tree and a Markov model was used to simulate the initial management after a first TURB of all new patients diagnosed with symptoms consistent with NMIBC and outcomes at short and long terms. In this model, the initial TURB could be achieved either with fluorescence in addition to white light, or with white light only. The main criteria of the model was based on the quality adjusted life years (QALY). The economic evaluation focused on the direct costs. The test's results and costs were determined from diagnosis until death of patients.
  
  
  RESULTS
  The use of photodynamic diagnosis during TURB resulted in an improvement in QALYs (0.075) and a reduction of € 670 of the costs compared to the conventional treatment with white light. Thus, the blue light resection was defined as a strategy called "dominant" over the TURB in white light.
  
  
  CONCLUSIONS
  In the context of the French health system, the model of the study showed that the blue light cystoscopy during TURB was associated with increased QALYs and reduced health spending. This kind of result is rare in oncology. This health economic analysis confirms the interest of hexylaminolevulinate acid in initial management of NMIBC, according to studies conducted in United Kingdom, Italy and Poland.
authors.affiliation: Service d'urologie, faculté de médecine Pierre-et-Marie-Curie, université Paris 6, hôpital de la Pitié-Salpêtrière, Assistance publique-hôpitaux de Paris, 83, boulevard Hôpital, 75013 Paris, France. Electronic address: morgan.roupret@psl.aphp.fr.
authors.forename: M
authors.initials: M
authors.lastname: Rouprêt
authors.affiliation: Service d'urologie, CHU de Toulouse, hôpital de Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, bâtiment H2-3(e) étage, 31059 Toulouse cedex, France.
authors.forename: B
authors.initials: B
authors.lastname: Malavaud
authors.affiliation: Inserm UMR 1027, département d'information médicale, centre hospitalier universitaire de Toulouse, 2, rue Viguerie, TSA 80035, 31059 Toulouse cedex 9, France.
authors.forename: L
authors.initials: L
authors.lastname: Molinier
authors.affiliation: Public Health Expertise, 157, rue du Faubourg-Saint-Antoine, 75011 Paris, France.
authors.forename: H
authors.initials: H
authors.lastname: Leleu
authors.affiliation: Public Health Expertise, 157, rue du Faubourg-Saint-Antoine, 75011 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Blachier
authors.affiliation: Laboratoire Ipsen, 65, quai Georges-Gorse, 92100 Boulogne-Billancourt, France.
authors.forename: F
authors.initials: F
authors.lastname: Marteau
mesh_terms: D000283:Administration, Intravesical; D000368:Aged; D000622:Aminolevulinic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000601:surgery*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D015653:Cystectomy / Q000191:economics* / Q000379:methods; D003558:Cystoscopy / Q000191:economics* / Q000379:methods; D005260:Female; D005453:Fluorescence; D005602:France / Q000453:epidemiology; D006801:Humans; D008027:Light; D008297:Male; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D064887:Observational Studies as Topic; D017319:Photosensitizing Agents / Q000008:administration & dosage; D011237:Predictive Value of Tests; D015995:Prevalence; D011788:Quality of Life; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000601:surgery*
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid; C419924:5-aminolevulinic acid hexyl ester
keywords: (MeSH): bladder neoplasms; (MeSH): tumeur de vessie; Carcinome urothélial; Costs; Coûts; Fluorescence; Progression; Recurrence; Récidive; Urothelial carcinoma