GALVESTON, TX — Higher upfront costs vs. improved recurrence outcomes are a tradeoff when incorporating blue light cystoscopy (BLC) into nonmuscle-invasive bladder cancer (NMIBC) management, according to a new study.
The study led by The University of Texas Medical Branch in Galveston, TX, pointed out that real-world data on the costs and outcomes of BLC for NMIBC are limited. The researchers, including participants from VAMCs in Los Angeles and Durham, NC, compared healthcare costs and oncologic outcomes associated with BLC vs. white light cystoscopy only (WLC) in patients with NMIBC.
The retrospective cohort study published in Urologic Oncology included NMIBC patients treated in the VA healthcare system between Jan.1, 1997, and Dec. 31, 2021. The investigators compared patients exposed to BLC after diagnosis with WLC-only patients. Propensity score matching (1:1) identified 311 BLC-exposed and 311 WLC-only patients, while outcomes included 5-year total and category-specific healthcare costs, NMIBC recurrence and recurrence-related cost offsets.
Among the 622 matched patients (311 BLC; 311 WLC), median age was 71 years, and 378 (61%) had high-risk disease.
The results indicated that BLC-exposed patients were more likely to receive intravesical BCG (190 [61%] vs. 133 [43%]; p < 0.01) and intravesical chemotherapy (149 [49%] vs. 86 [28%]; p < 0.01). The researchers reported that unadjusted 5-year total costs were higher with BLC ($108,411 vs. $66,734; p < 0.01), primarily due to outpatient costs ($90,788 vs. $55,529; p < 0.01). BLC also was associated with decreased risk of recurrence (HR 0.62, 95% CI 0.45 – 0.86), however. After accounting for recurrence-related cost offsets, the adjusted 5-year cost difference was $721 per patient, according to the report.
“In an equal-access setting, BLC exposure was associated with higher 5-year costs, largely driven by outpatient care,” the authors concluded. “However, lower recurrence rates reduced the net cost difference, resulting in near cost neutrality. These findings highlight the trade-off between higher upfront costs and improved recurrence outcomes when incorporating BLC into NMIBC management.”
- Nasrallah AA, Evans C, Gu L, Parrish JA, De Hoedt AM, Lapon J, McKee C, Aronson W, Freedland SJ, Williams SB. Costs of care and oncologic outcomes associated with blue light cystoscopy in an equal access setting: Results from the BRAVO study. Urol Oncol. 2026 Jun;44(6):70-79. doi: 10.1016/j.urolonc.2026.111090. Epub 2026 Apr 3. PMID: 41935944.