Blue light cystoscopy is tied to higher resource use, not health care cost, in NMIBC

A retrospective claims-based analysis found that blue light cystoscopy (BLC) was associated with greater bladder cancer–related health care utilization than white light cystoscopy (WLC) among patients with non–muscle invasive bladder cancer (NMIBC), but overall health care costs did not differ significantly between the 2 approaches.¹

The findings, published in JU Open Plus, provide real-world economic data on an enhanced cystoscopic imaging technique that has demonstrated improved detection of NMIBC, particularly carcinoma in situ (CIS).

"These real-world results are encouraging. They contribute to the clinical utility of BLC for NMIBC patients—as the BRAVO real world-study demonstrated—and demonstrate cost-neutrality of the procedure,” said principal investigator Mark D. Tyson, II, MD, MPH, in a news release on the results.² “BLC will continue to play an important role in improving quality of NMIBC diagnostics and care. Optimizing diagnostic strategies to maximize the accuracy of initial diagnosis and follow-up can impact costs and lead to improved patient outcomes.”

Study evaluates resource utilization and costs

Investigators conducted a retrospective cohort analysis using claims from the Optum Research Database. Patients who underwent BLC or WLC from June 2011 and May 2023 were identified, and patients in the WLC cohort were matched 6:1 to those in the BLC cohort based on index year and the time between bladder cancer diagnosis and cystoscopy. Inverse probability of treatment weighting (IPTW) was subsequently used to account for differences in baseline characteristics.

The final cohort consisted of 794 patients who underwent BLC and 4764 patients who underwent WLC.

Before weighting, claims coded for CIS were more common among patients undergoing BLC than among those undergoing WLC, at 19.6% and 8.8%, respectively (P < .001). BLC patients also had greater use of (71.8% vs 57.8%; P < .001), BCG (24.2% vs 15.8%; P < .001), and biomarker testing (65.0% vs 34.9%; P < .001)during the baseline period. The proportion of patients with CIS claims in the BLC vs WLC cohorts remained significant after IPTW (18.2% vs 9.4%; P < .001).

Following weighting, patients undergoing BLC had a mean of 1.3 bladder cancer–related ambulatory visits per month compared with 1.0 visit per month among WLC patients (P = .004). However, all-cause health care resource utilization was 3.47 vs 3.21 events per month, respectively, a difference that was not statistically significant (P = .11).

The economic analysis similarly found no statistically significant difference in total health care expenditures. Mean total costs were $2987.93 per patient per month for BLC compared with $2886.16 per patient per month for WLC (P = .65). Bladder cancer–specific costs were $1301.10 and $1246.60 PPPM, respectively (P = .75). Costs were inflation-adjusted to 2023 US dollars.

According to the authors, the findings suggest that greater utilization of BLC can be implemented in real-world practice without added financial burden.

Economic findings add to a growing real-world evidence base

The current claims analysis adds to several studies evaluating the economic consequences of BLC. Recently, the BRAVO study evaluated BLC vs WLC in 622 patients treated within the Veterans Affairs health care system. Published in 2026, that retrospective analysis found lower recurrence associated with BLC but higher unadjusted 5-year costs, primarily because of greater outpatient utilization.³ After accounting for costs associated with recurrence, the difference between the groups approached cost neutrality.

The authors of the BRAVO study concluded, “These findings highlight the trade-off between higher upfront costs and improved recurrence outcomes when incorporating BLC into NMIBC management.”

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