Comparison of molecular and conventional strategies for followup of superficial bladder cancer using decision analysis

Purpose: Patients with superficial bladder cancer require long-term surveil lance for recurrence. We compared the cost of cystoscopy and cytology (stan dard care) to that of urinary markers (modified care) for patients with a h istory of superficial bladder cancer. Materials and Methods: We constructed a decision analysis model that compar ed the 2 strategies for a hypothetical followup interval of 3 years. Probab ilities required for the decision tree were based on a cohort of 361 patien ts diagnosed with superficial bladder cancer from 1987 to 1997. Sensitivity analyses were used to determine whether test sensitivity and specificity w ould affect cost thresholds. Costs for each strategy were then applied to a ctual practice patterns. Results: The cost of modified care ranged from $158 to $228 for each follow up visit when using a urinary marker with a sensitivity and specificity of 95% and 77%, respectively. The cost of standard care was $240 for each foll owup visit. Based on sensitivity analyses the probability of disease recurr ence and urinary marker accuracy were important determinants of expected co sts. Mean number of followup assessments for patients followed more than 3 years was 4.3, 2.2 and 1.5 for years 1, 2 and 3, respectively. Cumulative c osts of modified care were lower than those of standard care. Conclusions: Urinary marker testing for followup of patients with superfici al bladder cancer is less expensive than the standard method of cystoscopy and urinary cytology based on our model. Future studies will be required to consider other factors that could affect the cost advantage of urinary mar kers, including indirect costs, the psychosocial impact of testing and diff erent surveillance frequencies.