OBJECTIVE: Development of a decision analytic model to estimate the budget impact on the Swedish health service of using a more effective diagnostic tool in conjunction with white light cystoscopy (WLC) in the management of superficial bladder cancer (SBC). Hexvix (hexaminolevulinate) fluorescence cystoscopy potentially allows more complete detection and delineation of tumours compared with WLC in bladder cancer diagnosis. METHODS: Model inputs, including procedure costs and clinical algorithms, are based on the bladder cancer diagnosis and treatment guidelines of the European Association of Urology (EAU), literature review and Swedish clinical practice. Several trials report less residual tumour at early re-resection following 5-ALA fluorescence-assisted TURB with 59% to 80% relative reduction in recurrence in the fluorescence group compared to WLC. Based on these findings, the model assumed a conservative 40% reduction in recurrence rate when Hexvix was used alongside WLC to guide TURB. The model projects the flow of all newly diagnosed SBC patients, following histological risk classification at first TURB, through treatment one year after diagnosis. It covers Hexvix use in the operating room to guide first TURB in all patients with suspicion of bladder cancer and all follow-up TURBs in patients with recurrent SBC. RESULTS: In the Swedish population of newly diagnosed bladder cancer patients, the model projects a reduction in the number of procedures required in the first year compared to WLC alone, i.e. 29 cystectomies and 1961 TURBs with Hexvix compared to 52 and 2141 with WLC. Avoidance of these procedures would result in $212,895 (SEK 1,561,908) reduction in costs to the Swedish health service the first year after diagnosis. CONCLUSIONS: The model predicts that use of Hexvix as an adjunct to WLC for all initial and follow-up TURBs in the first year following diagnosis will result in substantial cost savings for the Swedish health service.