Hexaminolevulinate Hydrochloride Blue-Light Flexible Cystoscopy in the Detection and Follow-Up of Nonmuscle-Invasive Bladder Cancer: Cost Consequences During Outpatient Surveillance in Sweden

Dansk, Viktor; Malmström, Per Uno; Bläckberg, Mats; Malmenäs, Maria

doi:10.2217/fon-2015-0021

Cited by 10 publications

(12 citation statements)

References 19 publications

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“…The model, based on the Swedish health care system, indicates that BLFC would allow more outpatient treatment with improved detection of recurrent tumors, resulting in reduced need for TURB, cystectomies, bed days, and operating room time. 20 BLFC use across all risk groups would have minimal budget impact (+1.6% total cost) over 5 years and would achieve cost savings in intermediate- and high-risk groups from year 2. 20 The actual cost benefit of BLFC in different health care settings needs to be confirmed in real-world studies.…”

Section: Discussionmentioning

confidence: 99%

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Can routine outpatient follow-up of patients with bladder cancer be improved? A multicenter prospective observational assessment of blue light flexible cystoscopy and fulguration

Zare

Grabe

Hermann

et al. 2018

RRU

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BackgroundThe aim of this prospective cohort study was to determine the feasibility of incorporating blue light flexible cystoscopy (BLFC) and biopsy/fulguration into routine outpatient follow-up of non-muscle invasive bladder cancer patients.MethodsThe study included patients with non-muscle-invasive bladder cancer (NMIBC) who were scheduled for routine follow-up. Hexaminolevulinate was instilled in the outpatient department, and the bladder was examined under white light and then with BLFC. Biopsies were taken from all suspicious lesions. Small tumors and suspicious lesions were fulgurated on site; patients with larger lesions were referred to the operating room for resection.ResultsThe study included 69 patients, with a mean age of 70 years (range 33–89 years) and a mean duration since NMIBC diagnosis of 8 years. Most patients had high-grade cancer at initial diagnosis (52/69) and were at high risk of recurrence (48/69). Two patients per hour could be assessed using outpatient BLFC. Preparation and instillation of hexaminolevulinate took less than 10 minutes per patient, and patients had an additional waiting time of 45–60 minutes following instillation, while the hexaminolevulinate solution was retained in the bladder before examination. Eleven patients had histologically confirmed tumors that were identified using both white light flexible cystoscopy and BLFC. An additional three patients had tumors that were identified by BLFC only: two with Ta tumors and one with carcinoma in situ. Of the 14 patients with confirmed tumors, 11 could be managed on site with fulguration, whereas three were referred to the operating room. No adverse events attributable to BLFC were reported.ConclusionRoutine outpatient management of patients with NMIBC using BLFC and on-site biopsy/fulguration is feasible, despite the additional time required for hexaminolevulinate instillation, and appears to allow early detection of recurrent lesions, which can be fulgurated without the need for hospitalization.

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Section: Discussionmentioning

confidence: 99%

“… 20 BLFC use across all risk groups would have minimal budget impact (+1.6% total cost) over 5 years and would achieve cost savings in intermediate- and high-risk groups from year 2. 20 The actual cost benefit of BLFC in different health care settings needs to be confirmed in real-world studies.…”

Section: Discussionmentioning

confidence: 99%

Can routine outpatient follow-up of patients with bladder cancer be improved? A multicenter prospective observational assessment of blue light flexible cystoscopy and fulguration

Zare

Grabe

Hermann

et al. 2018

RRU

Self Cite

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“…Initially targeting HALC to high-risk patients seems an appropriate means of introducing the use of this technique within a treatment centre. Thus, while HALC may lead to long-term benefits across all risk groups compared with WLC, high-risk patients seem to benefit most [16]. …”

Section: Discussionmentioning

confidence: 99%

“…A recent study from Sweden modelling the cost consequences of HALC found that the technique had a minimal cost impact if introduced across all risk groups, and reduced TURBs, cystectomies, bed days, and operating room time. Notably, the use of HALC translated into cost savings from year 2–5 in this model [16]. …”

Section: Discussionmentioning

confidence: 99%

Optimised photodynamic diagnosis for transurethral resection of the bladder (TURB) in German clinical practice: results of the noninterventional study OPTIC III

et al. 2016

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PurposeWhite light cystoscopy (WLC) is the standard procedure for visualising non-muscle invasive bladder cancer (NMIBC). However, WLC can fail to detect all cancerous lesions, and outcomes with transurethral resection of the bladder differ between institutions, controlled trials, and possibly between trials and routine application. This noninterventional study assessed the benefit of hexaminolevulinate blue light cystoscopy (HALC; Hexvix®, Ipsen Pharma GmbH, Germany) plus WLC versus WLC alone in routine use.MethodsFrom May 2013 to April 2014, 403 patients with suspected NMIBC were screened from 30 German centres to perform an unprecedented detailed assessment of the additional detection of cancer lesions with HALC versus WLC alone.ResultsAmong the histological results for 929 biopsy samples, 94.3 % were obtained from suspected cancerous lesions under either WLC or HALC: 59.5 % were carcinoma tissue and 40.5 % were non-cancerous tissue. Of all cancer lesions, 62.2 % were staged as Ta, 20.1 % as T1, 9.3 % as T2, 7.3 % as carcinoma in situ (CIS), and 1.2 % were unknown. Additional cancer lesions (+6.8 %) and CIS lesions (+25 %, p < 0.0001) were detected by HALC plus WLC versus WLC alone. In 10.0 % of patients, ≥1 additional positive lesion was detected with HALC, and 2.2 % of NMIBC patients would have been missed with WLC alone. No adverse events were observed.ConclusionsThe results of this study demonstrate that HALC significantly improves the detection of NMIBC versus WLC alone in routine clinical practice in Germany. While this benefit is statistically significant across all types of NMIBC, it seems most relevant in CIS.

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“…Studies reported on a range of different findings. Of the 37 studies identified from SLR searches, fifteen were cost studies, of which one evaluated total healthcare costs of bladder cancer in the US; 75 one was a US Markov model of healthcare costs by disease risk; 76 four were US database studies evaluating varying provider-level treatment intensity among Medicare beneficiaries aged ≥65 years; 12,13,77,78 three assessed diagnosis and monitoring costs; [79][80][81] three assessed different imaging technologies; [82][83][84] and two evaluated intravesical chemotherapy post-TURBT. 85,86 In addition, three budget impact models (BIMs) and eighteen CEAs were identified from SLR searches, of which twelve evaluated TURBT, mainly comparing diagnostic imaging during the procedure as well as comparing TURBT to other procedures or procedure setting.…”

Section: Economic Outcomesmentioning

confidence: 99%

<p>Humanistic and Economic Burden of Non-Muscle Invasive Bladder Cancer: Results of Two Systematic Literature Reviews</p>

Lee¹,

Kwon²,

Forsythe³

et al. 2020

CEOR

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Purpose: Non-muscle invasive bladder cancer (NMIBC) is a malignancy restricted to the inner lining of the bladder. Intravesical Bacillus Calmette-Guerin (BCG) following transurethral resection of the bladder tumor is the mainstay first-line treatment for high-risk NMIBC patients. Two systematic literature reviews (SLRs) were conducted to further assess the current evidence on BCG use in NMIBC and the humanistic and economic burden of disease. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, Embase ® and MEDLINE ® were searched using the Ovid platform to identify interventional or real-world evidence studies on the health-related quality of life (HRQoL) and economic burden in NMIBC. Limited evidence was found from initial economic SLR searches in NMIBC, so additional targeted searches for bladder cancer were conducted to expand findings. Results: Fifty-nine publications were included in the HRQoL SLR, of which 23 reported HRQoL and symptoms in NMIBC. At diagnosis, HRQoL was comparable with population norms but worsened considerably 2 years following diagnosis. Maintenance therapy with intravesical BCG was associated with reduced HRQoL, and treatment-related adverse events (AEs) resembled typical NMIBC symptoms. Twenty-two studies reported decreasing BCG compliance over time. Common AEs with BCG were frequent urination, lower urinary tract symptoms, pain, and hematuria. Forty-two publications were included in the economic SLR, of which nine assessed healthcare costs and resource use in NMIBC or bladder cancer. Highrisk disease and high-intensity treatment were associated with increased healthcare costs. Conclusion: NMIBC has a considerable symptomatic, HRQoL, and economic burden. Symptoms persisted and HRQoL worsened despite intravesical BCG treatment. NMIBC is a costly disease, with higher healthcare costs associated with increased risk of disease progression and recurrence. There is a high unmet need for safe and effective treatments that reduce the risk of disease progression and recurrence, provide symptomatic relief, and improve HRQoL for patients.

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Hexaminolevulinate Hydrochloride Blue-Light Flexible Cystoscopy in the Detection and Follow-Up of Nonmuscle-Invasive Bladder Cancer: Cost Consequences During Outpatient Surveillance in Sweden

Abstract: HAL BLFC allowed more outpatient treatment with improved recurrence detection and reduced transurethral resection of the bladder tumors, cystectomies, bed days and operating room time, with minimal cost impact across all risk groups, demonstrating the economic benefits of introducing HAL.

Cited by 10 publications

References 19 publications

Can routine outpatient follow-up of patients with bladder cancer be improved? A multicenter prospective observational assessment of blue light flexible cystoscopy and fulguration

Can routine outpatient follow-up of patients with bladder cancer be improved? A multicenter prospective observational assessment of blue light flexible cystoscopy and fulguration

Optimised photodynamic diagnosis for transurethral resection of the bladder (TURB) in German clinical practice: results of the noninterventional study OPTIC III

<p>Humanistic and Economic Burden of Non-Muscle Invasive Bladder Cancer: Results of Two Systematic Literature Reviews</p>

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