OBJECTIVES:

Narrow band imaging (NBI) is a technology used for endoscopic diagnosis and support during the treatment of lesions in non-muscle invasive bladder cancer (NMIBC). NBI has demonstrated improved sensitivity and specificity compared with white-light imaging (WLI), and is associated with lower cancer recurrence. Through these clinical benefits, NBI has the potential to provide cost-savings vs. WLI due to the associated reductions in healthcare resource utilisation. This analysis quantifies the economic benefit of NBI in NMIBC.

METHODS:

A cost-consequence analysis was conducted adopting the UK hospital perspective. A cohort of N=100 NMIBC-suspected patients enter the model and receive diagnosis with NBI or WLI cystoscopy. Based on diagnostic accuracy, patients are classified as: true positive (TP), true negative (TN), false positive (FP), or false negative (FN). Patients with a NMIBC diagnosis undergo transurethral resection of bladder tumor (TURBT), while patients diagnosed as cancer-free receive standard monitoring. After one year of observation, patients are stratified into three states: i) cancer-free; ii) recurrence; iii) non-diagnosed NMIBC. Patients with recurrence or non-diagnosed NMIBC can progress from non-invasive to invasive bladder cancer.

The model considers hospital costs related to equipment, reprocessing, maintenance, consumables / medication, staff, TURBT, recurrence management and disease progression. A micro-costing approach was adopted to calculate cystoscopy costs.

RESULTS:

NBI reduced the recurrence rate vs. WLI (16.9% vs. 37.4%, respectively), and resulted in cost-savings of £9,046 (overall costs: £170,577 vs. £179,623, respectively).

More NIMBC cases were detected with NBI vs. WLI (81 vs. 69 TP cases, respectively), resulting in increased TURBT costs (£19,309; £127,614 vs. £108,305, respectively). However, increased TURBT costs were offset by the reduction of recurrences, which determined cost-savings of £28,355 (£23,282 with NBI; £51,637 with WLI).

CONCLUSIONS:

This analysis suggests that NBI is dominant vs. WLI for detection and support during the treatment of NMIBC in UK hospitals.