OBJECTIVES: We describe the methods and results from a health technology assessment (HTA) of a new and less invasive bladder cancer test (urine-based CxBladder) that was considered for adoption at UW Medicine. We utilized hospital-based health technology assessment (Hb-HTA) best practices to determine whether this new test would have clinical value for UW Medicine.

METHODS: UW Medicine’s Hb-HTA program, Smart Innovation reviews new technologies throughout the system for adoption consideration. The program utilized a set of decision-making processes to evaluate the new test and engaged the technology sponsor (the clinical laboratory) as well as UW Medicine’s multi-disciplinary Laboratory Formulary Committee, finance, administration, physicians and executive leadership. We developed an HTA report that included a safety assessment, a synthesis of the published evidence, an estimated fiscal impact, a review of the established clinical guidelines, and an assessment of public and private payer coverage and reimbursement.

RESULTS: The CxBladder HTA report contained mixed evidence, however, the main concern was related to the test’s clinical validity. One study demonstrated the new test had a specificity of only 40% compared to the gold standard (cystoscopy). This low specificity indicates a high rate of false positives, resulting in unnecessary follow-up. There were also no clinical guidelines that recommended using CxBladder for bladder cancer screening. The clinical committee voted to not adopt the test, with an estimated cost savings (avoidance) of $1.5 million dollars annually.

CONCLUSIONS: It is paramount that healthcare leaders, hospitals, and clinicians remain objective about new and exciting medical technologies. Smart Innovation provided an objective pathway to effectively review and consider this new test, as well as determine if it met criteria for adoption. Because of the less invasive nature of CxBladder, this new and expensive test would have been adopted and incorporated into usual practice, potentially causing unnecessary care and significant waste.