Health Technology Assessment on Blue Light Cystoscopy for Non-Muscle Invasive Bladder Cancer

Condition Description – Bladder cancer is a malignant growth in the urinary bladder. Depending on the stage, it has two distinct types: non-muscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC). NMIBC refers to the earlier stage of bladder cancer that is confined to the urothelium and lamina propria, which are the first two layers of tissue that line the lumen of the urinary tract. NMIBC is the most common type of bladder cancer and makes up approximately 75% to 80% of all incident bladder cancer cases.

Current treatment options – Prevention of recurrence is the main goal of the treatment for NMIBC. Transurethral resection of bladder tumor (TURBT) is the standard first-line treatment for all NMIBC. TURBT is a surgical procedure that utilizes a cystoscope introduced into the bladder through the urethra. A cystoscope is utilized to allow visualization of bladder structure, and other instruments allow removal of tumor cells. A white light is used inside the bladder enabling visualization of the bladder structures. Depending on the risk of recurrence patients may receive other follow-up therapy.

Surveillance is also an important part of the care plan as the early identification of recurrent tumor is crucial in preventing progression. Standard surveillance of NMIBC involves periodic cystoscopy and cytology. Depending on the risk stratification, patients would be enrolled into different surveillance programs; some will last a lifetime.

Description of the Assessed Technology(ies) - Blue light cystoscopy (BLC) allows better visualization of the tumor, potentially leading to more thorough removal of cancerous tissue. A fluorescent agent, hexaminolevulinate is instilled into the patient’s bladder prior to the rigid cystoscopy. The agent preferentially accumulates in cancerous tissue. Under a blue light (360-450 nm) the cancerous tissue fluoresces bright pink whereas healthy tissue appears blue, thus enhancing visualization of tumors. The improved detection of tumors enables an optimal resection with a complete resection at the tumor margins as well as resection of small, difficult to see tumors.

Health Technology Assessment Committee’s Findings: 

After reviewing the available evidence, the Health Technology Assessment Committee found:

• Blue Light Cystoscopy (BLC) to be a clinically and cost-effective intervention for people with non-muscle invasive bladder cancer.
• This technology is expected to positively impact the patient experience by improving identification and early removal of cancerous tissue, which in turn may result in fewer return surgeries and follow-up care.
• There are considerable implementation issues that vary by site regarding available resources and compatibility with the BLC technology, specifically, within rural regions of BC.

Prior to implementation, HTAC suggested evaluation of capital costs. HTAC also found further dialogue with the British Columbia Cancer Agency and relevant health sector partners could identify how BLC might impact both the recommended surveillance and treatment guidelines for patients with non-muscle invasive bladder cancer along the patient care pathway for bladder cancer. It will be at the discretion of each health authority and/or relevant organizations to assess the value of potential benefits in comparison to the additional implementation costs.