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. 2009 Jun 15;115(12):2660-70.
doi: 10.1002/cncr.24311.

Treatment of nonmuscle invading bladder cancer: do physicians in the United States practice evidence based medicine? The use and economic implications of intravesical chemotherapy after transurethral resection of bladder tumors

Ralph Madeb  1 , Dragan Golijanin, Katia Noyes, Susan Fisher, Judith J Stephenson, Stacey R Long, Joy Knopf, Gary H Lyman, Edward M Messing
Affiliations

Treatment of nonmuscle invading bladder cancer: do physicians in the United States practice evidence based medicine? The use and economic implications of intravesical chemotherapy after transurethral resection of bladder tumors

Ralph Madeb et al. Cancer. .

Abstract

Background: Phase 3 clinical trials performed primarily outside the US demonstrate that intravesical instillation of chemotherapy immediately after transurethral resection of the bladder (TURB) decreases cancer recurrence rates. The authors sought to determine whether US urologists have adopted this practice, and its potential effect on costs of bladder cancer (BC) care.

Methods: By using 1997-2004 MEDSTAT claims data, the authors identified patients with newly diagnosed BC who underwent cystoscopic biopsy or TURB, and those who received intravesical chemotherapy within 1 day after TURB. Economic consequences of this treatment compared with TURB alone were modeled using published efficacy estimates and Medicare reimbursements. The authors used a time horizon of 3 years and assumed that this treatment was given for all newly diagnosed low-risk BC patients.

Results: Between 1997 and 2004, the authors identified 16,748 patients with newly diagnosed BC, of whom 14,677 underwent cystoscopic biopsy or TURB. Of these, only 49 (0.33%) received same-day intravesical instillation of chemotherapy. From 1997 through 2004, there has been little change in the use of this treatment. The authors estimated a 3-year savings of $538 to $690 (10% to 12%) per patient treated with TURB and immediate intravesical chemotherapy compared with TURB alone, reflecting a yearly national savings of $19.8 to $24.8 million.

Conclusions: Instillation of intravesical chemotherapy immediately after TURB has not been embraced in the US. Adopting this policy would significantly lower the cost of BC care.

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Figures

Figure 1
Figure 1
The algorithm to identify bladder cancer patients who received same day intravesical instillation of a chemotherapeutic agent post-TURB.
Figure 2
Figure 2
Figure 2A. Algorithm For The Treatment Of the recurrence of Non-Muscle Invasive Bladder Cancer Over A 3-Year Period with BCG Figure 2B. Algorithm for The Treatment of the recurrence of Non-Muscle Invasive Bladder Cancer Over A 3-Year Period with Mitomycin C
Figure 2
Figure 2
Figure 2A. Algorithm For The Treatment Of the recurrence of Non-Muscle Invasive Bladder Cancer Over A 3-Year Period with BCG Figure 2B. Algorithm for The Treatment of the recurrence of Non-Muscle Invasive Bladder Cancer Over A 3-Year Period with Mitomycin C
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References

    1. Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, et al. Cancer statistics. CA Cancer J Clin. 2006;56:106–30. - PubMed
    1. Madeb R, Messing EM. Gender, racial and age differences in bladder cancer incidence and mortality. Urol Oncol. 2004;22:86–92. - PubMed
    1. Messing EM. Urothelial tumors of the urinary tract. In: Walsh PC, et al., editors. Campbell’s Urology. 4. Vol. 8. Philadelphia: WB Saunders; 2002. pp. 2732–2784.
    1. Klan R, Loy V, Huland H. Residual tumor discovered in routine second transurethral resection in patients with stage T1 transitional cell carcinoma of the bladder. J Urol. 1991;146:316–8. - PubMed
    1. Solsona E, Iborra I, Ricos JV, Monros JL, Casanova J, Dumont R. Effectiveness of a single immediate mitomycin C instillation in patients with low risk superficial bladder cancer: short and long-term followup. J Urol. 1999;161:1120–3. - PubMed

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