Cost-effectiveness of fluorescence in situ hybridization in patients with atypical cytology for the detection of urothelial carcinoma

Bishoy A. Gayed, Casey Seideman, Yair Lotan

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Purpose Patients with atypical cytology and equivocal or negative cystoscopy pose a challenge due to uncertainty about the presence of cancer. We determined the cost-effectiveness of using fluorescence in situ hybridization assays to determine the need for biopsy in patients with atypical cytology and equivocal or negative cystoscopy. Materials and Methods Data from 2 large prospective studies evaluating the usefulness of fluorescence in situ hybridization in the setting of atypical cytology to detect urothelial carcinoma were combined. The data were used to calculate sensitivity and specificity for the UroVysion® fluorescence in situ hybridization assay in various clinical scenarios. Cost data were obtained from our institution and Medicare reimbursement rates. Evaluations with or without bladder biopsy and with or without upper tract evaluation were considered. Results The study included 263 patients with atypical cytology and equivocal (62) or negative (201) cystoscopy. In patients with equivocal cystoscopy (assuming biopsy was performed in the operating room) biopsy based on fluorescence in situ hybridization results saved $1,740 per patient ($3,267 vs $1,527 per patient) and avoided 42 biopsies compared to biopsy in all patients. If office based biopsies were used then cost savings using fluorescence in situ hybridization results were $95 per patient. Among patients with negative cystoscopy biopsy based on fluorescence in situ hybridization resulted in costs savings of $2,241 per patient, avoiding 167 biopsies, compared to biopsy in all patients. Assuming office based biopsy, the cost savings were $216 per patient. Conclusions The decision to perform biopsy based on fluorescence in situ hybridization assay in patients with atypical cytology and equivocal or negative cystoscopy was associated with a significant decrease in bladder cancer associated costs.

Original languageEnglish (US)
Pages (from-to)1181-1186
Number of pages6
JournalJournal of Urology
Volume190
Issue number4
DOIs
StatePublished - Oct 1 2013
Externally publishedYes

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Fluorescence In Situ Hybridization
Cost-Benefit Analysis
Cell Biology
Carcinoma
Biopsy
Cystoscopy
Cost Savings
Costs and Cost Analysis
Operating Rooms
Medicare
Urinary Bladder Neoplasms
Uncertainty
Urinary Bladder
Prospective Studies

Keywords

  • cost-benefit analysis
  • in situ hybridization fluorescence
  • tumor markers biological
  • urinary bladder neoplasms
  • watchful waiting

ASJC Scopus subject areas

  • Urology

Cite this

Cost-effectiveness of fluorescence in situ hybridization in patients with atypical cytology for the detection of urothelial carcinoma. / Gayed, Bishoy A.; Seideman, Casey; Lotan, Yair.

In: Journal of Urology, Vol. 190, No. 4, 01.10.2013, p. 1181-1186.

Research output: Contribution to journalArticle

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