(UroToday.com) The 2025 Society of Urologic Oncology (SUO) Annual Meeting was host to a bladder cancer poster session. Dr. Ali Nasrallah presented results from the BRAVO study evaluating the costs of care and oncologic outcomes associated with blue light cystoscopy (BLC) in an equal access setting.
Bladder cancer (BC) is the sixth most prevalent malignancy in the United States,1 and is associated with high treatment and lifetime costs. Non-muscle invasive bladder cancer (NMIBC) recurrence is a significant contributor to costs of care. The cost of management of recurrent NMIBC over one year is estimated at $31,375.2 BLC has been shown to improve tumor detection and help reduce recurrence rates.2 This study aimed to compare the healthcare costs and oncologic outcomes associated with BLC exposure versus white light cystoscopy only (WLC) in NMIBC.
This study included patients diagnosed with NMIBC between 1997 and 2021, within the Veterans Affairs (VA) Healthcare System. Two study cohorts were defined:
- Cohort 1: Exposed to BLC.
- Cohort 2: WLC-only.
Propensity score matching was performed, adjusted for demographic and clinical variables.
There was a total of 622 matched patients (311 BLC, 311 WLC). The primary study objective was to evaluate for differences in healthcare costs over 1, 2, and 5-year intervals in line with oncologic outcomes. A cost-offset analysis was performed utilizing recurrence-avoidance estimated cost savings. Recurrence avoidance baselines were derived from a published economic model by Clark et al.3
The baseline patient characteristics are summarized below. The two matched groups were well-balanced for age, gender, race, smoking status, and disease risk. There were notable differences in post-diagnosis treatments received – patients in the BLC exposure group were significantly more likely to have received BCG (61% vs 43%, p<0.01) and intravesical chemotherapy (49% vs 28%, p<0.01). The median number of TURBTs was 3 and 2 in the BLC and WLC groups, respectively (p<0.01). Recurrence was observed less frequency in the BLC-exposed group (20% vs 30%, p<0.01). There was no difference in progression outcomes (5% vs 7%, p=0.5).
Patients in the BLC-exposed group had:
- Fewer inpatient visits (0.8 vs 1.2 per patient per year [PPPY], p=0.05)
- Fewer ER visits (1.4 vs 2.2 PPPY, p<0.01)
- Higher 5-year total costs ($108,411 vs $66,734; p<0.01)
- This was mainly driven by higher outpatient costs ($90,788 vs $55,529, p<0.01)
However, given the lower recurrence rates with BLC and the additional costs related to management of recurrence, a cost-offset analysis showed that the 5-year costs of BLC exposure were $604 more per person versus WLC.
Dr. Nasrallah concluded as follows:
- In a real-world equal-access setting, BLC use was associated with lower NMIBC recurrences
- BLC use is associated with increased total costs over 5 years.
- Increased outpatient costs are the main driver (more intravesical therapy, closer surveillance)
- Accounting for recurrence cost offset and healthcare utilization savings, BLC use approached cost-neutrality after 5 years.
Presented by: Ali Nasrallah, MD, Division of Urology, Urology Resident, UTMB Health, Galveston, TX
Written by: Rashid K. Sayyid, MD, MSc, Assistant Professor, Urologic Oncologist, Department of Urology at The University of Arizona and Banner University Medical Center – Tucson, AZ, @rksayyid on X during the 2025 Society of Urologic Oncology (SUO) annual meeting held in Phoenix, AZ, between the 2nd and 5th of December 2025.
Related content: Blue Light Cystoscopy Outcomes and Cost Analysis from the BRAVO Study - Ali Nasrallah
References:
- Siegel RL, Kratzer TB, Giaquinto AN, et al. Cancer statistics, 2025. CA Cancer J Clin. 2025; 75(1):10-45.
- Clark O, Sarmento T, Eccleston A, et al. Economic impact of bladder cancer in the USA. Pharmacoecon Open. 2024; 8:837-845.
- Nasrallah AA, Das S, Evans C, et al. Oncologic outcomes of blue light cystoscopy in an equal access setting: Results of the BRAVO study. JU Open Plus. 2025; 3(3):e00017.