What is the annual cost of surveillance for recurrent bladder cancer?

Answer

Although the incidence of bladder cancer is less than that of prostate cancer, expenditures are almost twice as high for bladder cancer because of its chronic nature and the need for long-term surveillance. According to the US Agency for Health Research and Quality, annual expenditures are $2.2 billion for bladder cancer versus $1.4 billion for prostate cancer. This suggests a close assessment of surveillance techniques and standards is appropriate.

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Media Gallery

The classic appearance of carcinoma in situ as a flat, velvety patch. However, using special staining techniques such as 5-aminolevulinic acid, it has been shown that significant areas of carcinoma in situ are easily overlooked by conventional cystoscopy. Courtesy of Abbott and Vysis Inc.
Papillary bladder tumors such as this one are typically of low stage and grade (Ta-G1). Courtesy of Abbott and Vysis Inc.
Sessile lesions as shown usually invade muscle, although occasionally a tumor is detected at the T1-G3 stage prior to muscle invasion. Courtesy of Abbott and Vysis Inc.
Flexible cystoscopes such as this one facilitate endoscopic tumor surveillance with minimal morbidity and excellent visualization of the urothelium. Courtesy of Olympus America Inc.
The latest development in surveillance involves advances that integrate video chip technology on to the end of flexible cystoscopes. Courtesy of Olympus America Inc.
Rigid cystoscopes such as this one allow biopsy collection via in-office fulguration of small tumors. Such fulguration may be performed using electrocautery or laser. Courtesy of Olympus America Inc.
Resection of all visible tumors is possible using modern resectoscopes. Courtesy of Olympus America Inc.
Photograph in which fluorescence in situ hybridization centromere staining identifies aneuploidy of chromosome 3. Multiple instances of overexpression of the chromosome (note the multiple red dots, which identify centromeres of this chromosome) prove aneuploidy.

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Author

David A Levy, MD Assistant Professor of Surgery (Urology), Cleveland Clinic Lerner College of Medicine of Case Western Reserve University; Consulting Surgeon, Department of Regional Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation

David A Levy, MD is a member of the following medical societies: American Urological Association, Society of Urologic Oncology

Disclosure: Nothing to disclose.

Coauthor(s)

J Stephen Jones, MD, MBA, FACS Vice President of Medical Operations, Cleveland Clinic Regional Hospitals and Ambulatory Surgery Centers; Leonard Horvitz and Samuel Miller Distinguished Chair in Urological Oncology Research, Professor of Surgery (Urology), Cleveland Clinic Lerner College of Medicine at Case Western Reserve University

J Stephen Jones, MD, MBA, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Endourological Society, Society of University Urologists, Society of Urologic Oncology, SWOG, International Continence Society

Disclosure: Received honoraria from Cook for consulting; Received honoraria from HealthTronics for speaking and teaching; Received consulting fee from Photocure for other; Received grant/research funds from Analiza for other.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Bradley Fields Schwartz, DO, FACS Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, Society of University Urologists

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Endourological Society Board of Directors; President Elect North Central Section of the American Urological Association<br/>Serve(d) as a speaker or a member of a speakers bureau for: Cook Medical.

What is the annual cost of surveillance for recurrent bladder cancer?

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