Catto - Figure 23
Low risk NMI: Death
FIG. 23: The cost to achieve the result shown in the previous Figure is shown in this Figure. The numbers needed to screen (NNS) were 7 flexible cystoscopies (FCs) to detect one recurrence, 147 FCs to detect one grade progression, and between 375 and 675 FCs to detect one stage progression. That cost of finding that number of invasive events in the cohort of 699 primary GIpTa tumors was about £140,000 (around $224,000 at the time) per invasive event. This accumulated to almost £2,000,000 ($3,200,000) spent in cystoscopies per life saved, which seemed like a huge effort for relatively little return.
In other diseases, eg, breast cancer, huge benefits have been found by teaching patients about the risks and symptoms of recurrence and then asking them to self-present. Some of our patients who had invasive disease had worsening symptoms during the months leading up to cystoscopy, but they did not want to trouble us by reporting these, since they knew they had a planned cystoscopy in 3 or 4 months' time. So we have to ask whether better education and on-demand cystoscopy would have led to faster treatment in those patients.
References
Linton KD, Rosario DJ, Thomas F, et al. Disease specific mortality in patients with low risk bladder cancer and the impact of cystoscopic surveillance. J Urol. 2013;189:828−33 https://doi.org/10.1016/j.juro.2012.09.084
