Should we screen for bladder cancer in a high-risk population?: A cost per life-year saved analysis

Cancer. 2006 Sep 1;107(5):982-90. doi: 10.1002/cncr.22084.


Background: The U.S. Food and Drug Administration recently approved screening high-risk patients for bladder cancer using urine-based markers. The cost and life-years saved associated with bladder cancer screening were evaluated.

Methods: A Markov model was created to estimate cumulative cancer-related costs and efficacy of screening (vs. no screening) of a high-risk population for bladder cancer using a urine-based tumor marker over a 5-year period. Assumptions were based on literature review of survival and progression rates for patients with bladder cancer and costs associated with different bladder cancer disease states.

Results: Screening for bladder cancer in a population with a 4% incidence of bladder cancer resulted in a gain of 3.0 life years per 1000 subjects at a cost savings of $101,000 for the population, assuming a 50% downstaging in the screened population from muscle-invasive to nonmuscle-invasive disease. One-way sensitivity analyses found that screening is the most cost-effective strategy if cancer incidence is >1.6%, tumor marker costs <$126, marker sensitivity is >26%, marker specificity is >54%, downstaging with screening is >20%, and office cystoscopy costs <$694. Varying costs of cystectomy, transurethral resection of bladder tumor (TURBT), chemotherapy, end-of-life care, costs of metastatic disease, and a computed tomography scan over a wide range did not affect the superiority of screening.

Conclusions: The model found that urine-based markers are cost-effective in a high-risk population. Prospective randomized trials in a completely asymptomatic high-risk cohort are indicated before bladder cancer screening can be recommended.

Publication types

  • Evaluation Study

MeSH terms

  • Biomarkers, Tumor / analysis*
  • Biomarkers, Tumor / urine
  • Cost-Benefit Analysis
  • Costs and Cost Analysis
  • Cystoscopy / economics
  • Cytological Techniques / economics
  • Decision Support Techniques
  • Humans
  • Markov Chains
  • Risk
  • Sensitivity and Specificity
  • Urinary Bladder Neoplasms / diagnosis*
  • Urinary Bladder Neoplasms / economics
  • Urinary Bladder Neoplasms / pathology


  • Biomarkers, Tumor