Economic impact of tumor markers in bladder cancer surveillance

OBJECTIVES Bladder cancer invokes the highest cost per patient from diagnosis to death and is the fifth most expensive cancer to treat overall, exceeding $3.4 billion annually. Current surveillance regimens require intense follow-up contributing to high cost and emotional burden. Bladder tumor markers hold the promise to reduce these costs, yet have not been widely adopted in oncological practice. We assessed the cost-effectiveness of bladder tumor markers in surveillance routines. METHODS A MEDLINE search of all available literature concerning bladder tumor markers and cost-effectiveness was performed. We reviewed retrospective and prospective studies, reviews, opinion papers, decision analyses, and cost-effectiveness analyses. RESULTS Bladder tumor markers exist in various stages of development and efficacy. Sensitivity and specificity values have been reported across a wide range, with tumor markers generally possessing a higher sensitivity and lower specificity than urine cytology. Several cost-effectiveness analyses have shown tumor markers significantly lower the cost of bladder cancer surveillance when using a modified regimen that lengthens intervals between cystoscopies. However, many of the studies rely on overconfident sensitivity and specificity estimates and do not incorporate data specific to recurrent bladder cancer. No comprehensive study incorporating utility analysis has been performed. CONCLUSIONS Bladder tumor markers cannot definitively replace cystoscopy in surveillance regimens given the current evidence. Recent reports suggest potential for tumor markers to control the financial and emotional cost of bladder cancer care and improve quality of life. Until prospective analyses incorporating quality of life outcomes are performed, wider adoption of bladder tumor markers will be hampered.