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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.

Publication ,  Journal Article
Madeb, R; Golijanin, D; Noyes, K; Fisher, S; Stephenson, JJ; Long, SR; Knopf, J; Lyman, GH; Messing, EM
Published in: Cancer
June 15, 2009

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.

Duke Scholars

Published In

Cancer

DOI

ISSN

0008-543X

Publication Date

June 15, 2009

Volume

115

Issue

12

Start / End Page

2660 / 2670

Location

United States

Related Subject Headings

  • Urinary Bladder Neoplasms
  • United States
  • Randomized Controlled Trials as Topic
  • Practice Patterns, Physicians'
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Humans
  • Evidence-Based Medicine
  • Combined Modality Therapy
  • Chemotherapy, Adjuvant
 

Citation

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MLA
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Madeb, R., Golijanin, D., Noyes, K., Fisher, S., Stephenson, J. J., Long, S. R., … Messing, E. M. (2009). 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. Cancer, 115(12), 2660–2670. https://doi.org/10.1002/cncr.24311
Madeb, Ralph, Dragan Golijanin, Katia Noyes, Susan Fisher, Judith J. Stephenson, Stacey R. Long, Joy Knopf, Gary H. Lyman, and Edward M. Messing. “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.Cancer 115, no. 12 (June 15, 2009): 2660–70. https://doi.org/10.1002/cncr.24311.
Journal cover image

Published In

Cancer

DOI

ISSN

0008-543X

Publication Date

June 15, 2009

Volume

115

Issue

12

Start / End Page

2660 / 2670

Location

United States

Related Subject Headings

  • Urinary Bladder Neoplasms
  • United States
  • Randomized Controlled Trials as Topic
  • Practice Patterns, Physicians'
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Humans
  • Evidence-Based Medicine
  • Combined Modality Therapy
  • Chemotherapy, Adjuvant