AUA 2026: new studies demonstrated Blue Light Cystoscopy benefits in high-risk NMIBC management and cost comparison study
In the Poster and Podiums session on
"Blue Light Cystoscopy Enables Earlier CIS Recognition and Can Guide Risk-Appropriate Management of High-Risk Non–Muscle-Invasive Bladder Cancer: Real-World Outcomes from a
The objective of this study was to evaluate whether blue light cystoscopy (BLC®) improves early recognition of CIS/high-risk disease and helps inform clinical decision making in real-world practice. The study looked at 794 BLC and 4,764 matched WLC patients from the Optum Research Database (2016–2023).
Blue light cystoscopy (BLC) was found to significantly improve early detection of carcinoma in situ (CIS) and high-risk non–muscle-invasive bladder cancer compared to white light cystoscopy (WLC) using claims from the OPTUM database.
Specific findings include:
- BLC was associated with significantly higher CIS detection (8.5% vs. 3.4%) and cystectomy rates (4.6% vs. 2.3%)
- Increased Bacillus Calmette-Guérin (BCG) therapy use (31.0% vs. 15.9%) that persisted over approximately 3.5 years of follow-up
- These differences remained significant beyond the initial 90 days, indicating durable diagnostic sensitivity and facilitating earlier, risk-appropriate treatment decisions, which supports broader adoption of BLC for improved clinical and economic outcomes in managing high-risk bladder cancer
The authors conclude: "BLC provides durable diagnostic sensitivity for CIS, is associated with high levels of BCG use and may enable earlier initiation of appropriate therapy. BLC therefore may serve as a triage tool: identifying patients suitable for bladder-sparing drugs while directing truly high-risk cases to early definitive treatment. This risk-appropriate management pattern supports clinical and economic rationale for broader BLC adoption."
Read the abstract: https://www.auajournals.org/doi/abs/10.1097/01.JU.0001191388.74345.c9.24
In the "
"Costs of Care and Oncologic Outcomes Associated with Blue Light Cystoscopy in an Equal Access Setting: Results from the BRAVO Study" by
This abstract compared costs in non-muscle-invasive bladder cancer (NMIBC) care, incurred by white light cystoscopy (WLC) versus blue light cystoscopy (BLC®). Results of the real-world evidence study showed that while BLC was associated with higher initial costs of treatment than WLC, lower recurrence rates in the BLC patient cohort drive cost neutrality overall.
"Bladder cancer is associated with high treatment costs. A significant portion of cost is related to the high rates of cancer recurrence. In our study, utilization of BLC in the management of NMIBC was associated with modestly higher healthcare costs compared to white light. However, the majority of cost was related to increased use of guideline recommended intravesical therapy in the BLC cohort due to early detection of tumor. Early detection facilitated by BLC, appropriate intravesical therapy, and reduced recurrence significantly narrowed the cost differential that approached net cost neutrality compared to WL while providing superior clinical outcomes. These findings provide real-world cost data to aid in the decision-making process for utilizing BLC particularly in the care of high-risk NMIBC patients," said Dr.
The BRAVO study (Bladder Cancer Recurrence Analysis in Veterans and Outcomes) is a propensity score matched, retrospective analysis evaluating outcomes following BLC compared to WLC alone in 622 patients from the
Results:
- BLC vs. WLC patients were more likely to receive intravesical BCG (61% vs 43%; p<0.01) and intravesical chemotherapy (49% and 28%, p<0.01), respectively.
- BLC use was associated with decreased risk of recurrence (HR 0.62, p<0.01)
- Initial total costs over 5 years were higher in the BLC group (
$108,411 vs$66,734 ; p<0.01), with outpatient costs being the main driver ($90,788 vs$55,529 ; p<0.01). - A cost-offset analysis showed that the 5-year costs of BLC exposure were only
$721 more per person versus WLC due to shorter hospital stays, fewer emergency visits, and fewer recurrence events.
Conclusions: In a real-world equal-access setting, initial 5-year total costs for BLC were higher, mostly driven by outpatient costs likely related to increased utilization of intravesical therapies and closer surveillance in BLC patients. However, given lower recurrence rates with BLC and accounting for the costs of treating recurrence, the adjusted cost difference approaches net neutral.
Read the abstract: https://www.auajournals.org/doi/10.1097/01.JU.0001191732.85178.cb.03
Other sessions in the AUA's scientific program highlighted the role of flexible blue light cystoscopy in alternative diagnostic procedures, to ensure thorough detection of bladder tumors. Notable sessions on Transurethral laser ablation (TULA):
- Determinants of Improved Tumor Visibility Under Blue Light During Transurethral Laser Ablation: A Single Center Descriptive Cohort (Frederico Ceria)
- Blue Light Guided Transurethral Laser Ablation (TULA) for NMIBC: First
UK Single Center Experience Cohort on Recurrence Free Survival (Sandhu)
"At AUA and EAU 2026 congresses these past weeks, we have seen the paradigm shift towards personalized medicine translated into important scientific studies and experts seeking consensus on the optimal use of precision diagnostic solutions for patient sub-groups. The availability of ever more data points from various AI-enhanced tests and biomarkers makes the future of precision medicine – starting with early diagnoses – appear very promising," said Anders Neijber,
*NMIBC: Non-muscle invasive bladder cancer
**TURBT: trans-urethral resection of bladder tumors
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About Bladder Cancer
Bladder cancer ranks as the 8th most common cancer worldwide – the 5th most common in men – with 1 949 000 prevalent cases (5-year prevalence rate)1a, 614 000 new cases and more than 220 000 deaths in 2022.1b
Approx. 75% of all bladder cancer cases occur in men.1 It has a high recurrence rate with up to 61% in year one and up to 78% over five years.2 Bladder cancer has the highest lifetime treatment costs per patient of all cancers.3
Bladder cancer is a costly, potentially progressive disease for which patients have to undergo multiple cystoscopies due to the high risk of recurrence. There is an urgent need to improve both the diagnosis and the management of bladder cancer for the benefit of patients and healthcare systems alike.
Bladder cancer is classified into two types, non-muscle invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC), depending on the depth of invasion in the bladder wall. NMIBC remains in the inner layer of cells lining the bladder. These cancers are the most common (75%) of all BC cases and include the subtypes Ta, carcinoma in situ (CIS) and T1 lesions. In MIBC the cancer has grown into deeper layers of the bladder wall. These cancers, including subtypes T2, T3 and T4, are more likely to spread and are harder to treat.4
1 Globocan. a) 5-year prevalence / b) incidence/mortality by population. Available at: https://gco.iarc.fr/today, accessed [February 2024].
2 Babjuk M, et al. Eur Urol. 2019; 76(5): 639-657
3 Sievert KD et al. World J Urol 2009;27:295–300
4 Bladder Cancer.
About Hexvix
®
/Cysview
®
(hexaminolevulinate HCl)
Hexvix/Cysview is a drug that preferentially accumulates in cancer cells in the bladder, making them glow bright pink during Blue Light Cystoscopy (BLC®). BLC with Hexvix/Cysview, compared to standard white light cystoscopy alone, improves the detection of tumors and leads to more complete resection, fewer residual tumors, and better management decisions.
Cysview is the tradename in the
The following safety information is solely included to comply with
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