A slide of bladder cancer

Additional bladder cancer tests may have little benefit, but soaring costs

GALVESTON, Texas – People with a specific type of low-risk bladder cancer may be getting additional tests and treatments with little to no medical benefit, a new JAMA article reports.

“That translates to soaring costs of the most expensive cancer to treat—bladder cancer,” said Dr. Stephen B. Williams, Professor and Chief of Urology at the University of Texas Medical Branch (UTMB) where he is also Medical Director for High Value Care for the UTMB Health System. 

Williams is the senior and corresponding author of the study, published March 18.

People diagnosed with low-grade papillary non-muscle invasive bladder cancer had a significant increase in testing even though they were at a lower risk of this cancer progressing, Williams said.

Researchers studied data from 13,054 patients aged 66 to 90 years old with this diagnosis from 2004 to 2013. 

“Despite low rates of disease recurrence or progression, rates of surveillance testing increased during the study period,” Williams said.

Low-risk non-muscle invasive bladder cancer comprises almost 70% of patients initially diagnosed with bladder cancer and is associated with extremely low rates of progression and cancer deaths, but these patients may often receive non-guideline recommended and potentially costly surveillance and treatments.

Cystoscopy, upper tract imaging and urine cytologic testing all increased for these patients. 

The annual median 1-year cost of care for patients with low-grade non-invasive disease increased by 60% over the study period—from $34,792 to $53,986—despite disease progression only occurring in 0.4% of patients.

The annual cost of care increased over time, particularly among patients with recurrent disease. 

The researchers concluded that if treatment adhered to practice guidelines and limited testing and overtreatment, it could keep the cost of care lower without compromising cancer outcomes, and it would improve value to the patient, Williams said.

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