OBJECTIVES: Bladder cancer is a common malignancy with ~70,500 incident cases per year in the US; 70% present as non-muscle invasive bladder cancer (NMIBC). Perioperative instillation of chemotherapy after transurethral resection of the bladder (TURBT) can reduce the risk of recurrence. Our objective was to estimate the loss of quality-adjusted life years (QALY) due to unnecessary recurrences for patients not receiving perioperative chemotherapy (PC).  METHODS: A decision-tree model estimated the loss of QALYs following recurrence in NMIBC patients not receiving PC. Therapy utilization rates were obtained from a chart review study of 1010 NMIBC patients treated by 259 US urologists.  In this sample, 17% of patients received PC after the initial TURBT and 27% received perioperative therapy after the first recurrence.  In addition, 48.6% received induction therapy with BCG (85%) or mitomycin-C (MMC, 15%) after the first recurrence.  The estimated 2-year recurrence rates in NMIBC patients were 53% with TURBT alone and 36% with TURBT and PC. QALY estimates were obtained from literature with disutilities of -0.10 for each resection, -0.026 for BCG therapy, and an assumed -0.01 for MMC therapy.  RESULTS: According to estimates, 49,350 new cases of NMIBC are expected in the US in 2010; 100% utilization of PC would result in avoidance of 6,962 bladder tumor recurrences.  The model estimates that 911 QALYs are lost over a 2-year time period from preventable recurrences.  This equates to 0.02 QALYs for all patients undergoing TURBT.  An estimate of disutility at the first recurrence indicates a gain of nearly 47 quality-adjusted days per avoidable recurrence and ~8 days per new NMIBC case if intravesical PC was utilized. CONCLUSIONS: A substantial number of QALYs are lost each year due to underuse of intravesical PC.  Increased use of PC could reduce the humanistic burden of unnecessary recurrences in NMIBC.