Systematic review of the clinical and cost-effectiveness of photodynamic diagnosis and urine biomarkers (FISH, ImmunoCyt, NMP22) and cytology for the detection and follow-up of bladder cancer

Summary

This health technology assessment found that photodynamic diagnosis had higher sensitivity than white light cystoscopy in detecting bladder cancer and was better at detecting more aggressive, higher risk tumours. All three biomarkers (FISH, ImmunoCyt and NMP22) had higher sensitivity but lower specificity than cytology. However, these advantages have to be weighed against the disadvantages of a higher false-positive rate leading to unnecessary additional biopsies and potentially additional unnecessary investigations. Taking into account the assumptions made in the economic model, strategies involving biomarkers and/or photodynamic diagnosis provide additional benefits at a cost that society might be willing to pay. Strategies replacing white light cystoscopy with photodynamic diagnosis provide more life-years but it is unclear whether they are worth the extra cost.

This project was commissioned by the NIHR HTA programme.

Contact

Cynthia Fraser; c.fraser@abdn.ac.uk

Status

Completed

Publications

Mowatt G, N'Dow J, Vale L, Nabi G, Cook JA, Fraser C, Griffiths TRL, Aberdeen Technology Assessment Review Group. Photodynamic diagnosis of bladder cancer compared with white light cystoscopy: systematic review and meta-analysis. Int J Technol Assess Health Care 2011;27(1):3-10.

Mowatt G, Zhu S, Kilonzo M, Fraser C, Griffiths TRL, N'Dow J, Nabi G, Cook JA, Vale L. Systematic review of the clinical effectiveness and cost-effectiveness of photodynamic diagnosis and urine biomarkers (FISH, ImmunoCyt, NMP22) and cytology for the detection and follow-up of bladder cancer. Health Technol Assess 2010;14(4):1-331.