The present economic analysis by Neal Shore, MD, FACS, and Meghan B. Gavaghan, MPH, quantifies the clinical and economic impact of the incorporation of white light cystoscopy (WLC) + blue light cystoscopy (BLC®) in the management of NMIBC in ambulatory surgical centers (ASCs) compared to WLC alone considering current Center for Medicare Services (CMS) patient-physician coverage and reimbursement.
The authors built a budget impact model to assess projected ASC costs for a cohort of 50 newly diagnosed bladder cancer patients over a 2-year follow-up comparing white light cystoscopy (WLC) alone versus WLC + blue light cystoscopy (BLC®). Treatment and surveillance intervals were based on AUA/SUO clinical guidelines. Clinical and cost metrics for staging and biopsy rates were assessed, with cost inputs based on Medicare reimbursement rates. In the published clinical and health economic model, use of BLC resulted in the identification of 5 additional NMIBC recurrences compared to white light cystoscopy alone. There was an associated increased cost of performing BLC in an ASC setting, with a net increase in the total cost of care for NMIBC of $110 per cystoscopy over a two-year period. If recurrences missed using WLC alone were to progress prior to detection, the model projects an increase in treatment costs borne by Medicare of $9,097-$34,538 due to more intensive treatments required for more advanced disease.
The results of the model reinforce the clinical value of the use of BLC in all care settings to improve visualization and reduce the risk of recurrence. The findings also reinforce the need for fair and equitable reimbursement in all sites of care. In January 2023, CMS took important steps to improve site neutrality by increasing Medicare payment rates for use of BLC in the ASC setting, but inequities remain that serve to favor use of BLC in hospital outpatient departments (HOPDs) rather than ASCs. Additional steps might be taken in the future for additional payment increases to facilitate broad access to BLC in the ASC setting.
Written by:
- Neal Shore, MD, FACS, Carolina Urologic Research Center, Atlantic Urology Clinics, Myrtle Beach, SC
- Meghan B. Gavaghan, MPH, Ipsos Healthcare, New York, NY
- Edsall AE, Kyle CC, Ferguson G. Cost savings associated with use of ambulatory surgical centers (ASC) in lieu of outpatient hospital settings (OHS) for transurethral resection of bladder tumors (TURBT). Scientific Forum Quality, Safety, and Outcomes. 2016;223(4):E33.