Economic benefit of photodynamic diagnosis-assisted TURBT

Abstract

  Transurethral resection of bladder tumors (TURBT) is an essential endoscopic surgery as the starting point for bladder cancer treatment, enabling tumor removal, diagnosis, and staging. However, the biological features of bladder cancer including residual tumor at the resection margin and the presence of invisible carcinoma in situ lead to compromising oncological outcomes. Seven years have passed since TURBT combined with photodynamic diagnosis (PDD-TURBT) using oral 5-aminolevulinic acid hydrochloride was approved by Japanese insurance in December 2017. This intraoperative imaging technology has contributed to improving treatment outcomes by compensating conventional white-light TURBT and by leveling surgical skills. It is the time to clarify the true clinical significance of this new imaging technology from a variety of perspectives, including efficacy, safety, and medical economics. Much attention and research has been focused on oncological aspects such as bladder recurrence, progression, and time to cancer death, as well as functional aspects such as side effects, complications, quality of life, and satisfaction to date. However, evidence regarding the economic benefits of PDD-TURBT is missing. Thus, this paper evaluates the PDD-TURBT by the economic aspects and overviews real-world data analysis of our department.