Cost Effectiveness of Fluorescence in Situ Hybridization in Patients with Atypical Cytology for the Detection of Urothelial Carcinoma
Gayed BA, Seideman C, Lotan Y. J Urol. 2013 Apr 9. pii: S0022-5347(13)04026-3. doi: 10.1016/j.juro.2013.03.117. [Epub ahead of print]


UT Southwestern Medical Center,Urology.



Patients with atypical cytology and equivocal or negative cystoscopies pose a challenging problem due to uncertainty about presence of cancer. In the current study we determined the cost-effectiveness of utilizing FISH assays to determine the need for biopsy in patients with atypical cytology and equivocal or negative cystoscopies.


Data from two large prospective studies evaluating the utility of FISH in the setting of atypical cytology to detect urothelial carcinoma was combined. The data was used to calculate sensitivity and specificity for the Urovysion FISH assay in different clinical scenario. Cost data was obtained from our institution and Medicare reimbursement rates. Evaluation with or without bladder biopsy and with or without upper tract evaluation were considered.


The study included 263 patients with atypical cytology and either equivocal (62) or negative (201) cystoscopy. In patients with an equivocal cystoscopy (assuming biopsy done in operating room (OR)), biopsy based on FISH results saved $1740/pt ($3267/pt vs. $1527/pt) and avoided 42 biopsies compared to biopsying all patients. If office based biopsies are used then cost savings using FISH results is $95/pt. In patients with negative cystoscopy, biopsying based on FISH resulted in costs savings of $2241/pt avoiding 167 biopsies compared to biopsying everyone. Assuming office-based biopsy, the cost savings are $216/pt.


The decision to biopsy patients based on FISH assay in patients with atypical cytology and equivocal or negative cystoscopy was associated with a significant decrease in bladder cancer associated costs.