Environmental & Social Information • Oct 6, 2023
Environmental & Social Information
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New Health Economic analysis in France concludes there is insignificant cost difference between White Light and Blue Light Cystoscopy use when applying ccAFU guidelines
Press release - Oslo, Norway, October 6, 2023: Photocure ASA, The Bladder Cancer
Company, announces the publication of "A cost-consequences and budget impact
analysis of blue light-guided cystoscopy with Hexvix[®] in patients diagnosed
with non-muscle-invasive bladder cancer in France" in the peer-reviewed
international Journal of Medical Economics this week. This health economic
analysis aims to assess the financial impact of widely adopting Blue Light
Cystoscopy (BLC[®]) as recommended in the French ccAFU guidelines. A budget
impact model (BIM) was developed, that simulates the overall costs of
implementing a range of strategies involving the use of BLC, with analyses then
undertaken to determine the cost consequences for individual hospitals if
implementing the recommended management approach.
The analysis, led by Dr. Jonathan Belsey, [Health Economist & Managing Director
of JB Medical Ltd), details that clinical evidence, such as published in the
recent Cochrane review, supports the benefits of BLC over White Light
Cystoscopies (WLC) alone on the detection of bladder tumors and time to first
recurrence as well as an extended time to disease progression in patients
managed with BLC-assisted TURBT*.
The most recent ccAFU (Comité de cancérologie de l'Association française
d'urologie) guidelines recommend the use of BLC in a number of different
positions in the care pathway for NMIBC. The study authors explain: "The health
economic impact of this strategy has been evaluated using a cost-utility
analysis, from the perspective of the French healthcare system, and was found to
be dominant over WLC - meaning that its use results in better outcomes and lower
costs overall. Despite the existence of a clear clinical and economic evidence
base, however, concerns around the potential budgetary impact of the widespread
adoption of BLC have led to a degree of reluctance to adopt the technology."
ccAFU guidelines are detailed as follows: ".the French guidelines make strong
recommendations that BLC should be used: for the initial diagnostic TURBT in all
but the smallest unifocal tumors; for the second look cystoscopy when cytology
and the absence of papillary lesions with WLC suggest the presence of CIS; for
treating recurrent NMIBC** in all low-risk patients, Small Ta low grade tumors
in intermediate-risk patients, Suspicion of CIS in high-risk patients."
The budget impact model was developed as an interactive tool to provide
organisation-specific results. For illustrative purposes, results have been
analysed for 2 different theoretical scenarios: 1.) a large public hospital
implementing the specific BLC recommendations within the ccAFU guidelines for
300 new patients per year and 2.) a small private hospital, using BLC in a more
high-risk targeted subgroup from a cohort of 100 new patients per year.
The study publication presents the model results estimating the financial
consequences of implementing this strategy for an individual hospital within the
French healthcare system. Although BLC incurs an additional cost of Euro 360 per
case for the Hexvix instillation, this cost is partially offset by a reduced
requirement for subsequent TURBT, attributable to the anticipated reduction in
disease recurrence rates. Based on the two scenarios explored in this paper,
full implementation of the ccAFU guideline recommendations would be expected to
yield a net cost increase of around Euro 269 per procedure, while a more targeted
strategy based on a higher risk subgroup treated in the private sector was shown
to yield a net cost differential of Euro 133 per patient. Given that in France the
mean overall cost of care for these patients ranges from Euro 1,991 in the private
sector to Euro 3,376 in the public sector, it can be seen that the use of BLC is
likely to be associated with an incremental cost of around 5-10% of the index
procedural cost.
The BIM focused on direct medical costs incurred in the French healthcare
system. Recurrence rates for BLC-assisted patients were estimated by applying a
single overall hazard ratio estimate to all patient groups. All the published
data for this outcome, however, relate to the time to the first episode of
recurrence. Any residual benefit of BLC in reducing the risk of second or
subsequent recurrences will therefore not have been captured in this analysis,
potentially underestimating the total cost savings relating to reduced future
event rates. In addition, impact of BLC on disease progression was also excluded
from the calculation. The authors conclude: "Given the high costs of managing
progression to MIBC***, this will have potentially had a significant negative
impact on the cost offset calculated by the model.Using a model of patient care
that reflects the current recommendations of the ccAFU in France, we have shown
that the additional expenditure required to implement BLC-assisted TURBT within
individual hospitals is modest and not disproportionate to the overall cost of
care for these patients. More nuanced targeting of BLC use has the potential to
further improve the budget impact, while future research relating to subsequent
event rates and progression risk offer the potential to move towards cost
neutrality.""
Read the full publication here: https://doi.org/10.1080/13696998.2023.2267929
*TURBT: Transurethral resection of bladder tumor
**NMIBC: Non-muscle invasive bladder cancer
***MIBC: Muscle invasive bladder cancer
Note to editors:
All trademarks mentioned in this release are protected by law and are registered
trademarks of Photocure ASA
About Bladder Cancer
Bladder cancer ranks as the 8[th] most common cancer worldwide - the 5[th] most
common in men - with 1 720 000 prevalent cases (5-year prevalence rate)[1a], 573
000 new cases and more than 200 000 deaths in 2020.[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 [January 2022].
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. American Cancer Society. https://www.cancer.org/cancer/bladder
-cancer.html
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 U.S. and Canada, Hexvix[ ]is the tradename in
all other markets. Photocure is commercializing Cysview/Hexvix directly in the
U.S. and Europe and has strategic partnerships for the commercialization of
Hexvix/Cysview in China, Chile, Australia, New Zealand and Israel. Please refer
to https://photocure.com/partners/our-partners for further information on our
commercial partners.
About Photocure ASA
Photocure: The Bladder Cancer Company delivers transformative solutions to
improve the lives of bladder cancer patients. Our unique technology, making
cancer cells glow bright pink, has led to better health outcomes for patients
worldwide. Photocure is headquartered in Oslo, Norway and listed on the Oslo
Stock Exchange (OSE: PHO). For more information, please visit us at
www.photocure.com, www.hexvix.com, www.cysview.com
For further information, please contact:
Dan Schneider
President and CEO
Photocure ASA
Email: [email protected]
Erik Dahl
CFO
Photocure ASA
Tel: +4745055000
Email: [email protected]
David Moskowitz
Vice President, Investor Relations
Photocure ASA
Tel: +1 202 280 0888
Email: [email protected]
Media and IR enquiries:
Geir Bjørlo
Corporate Communications (Norway)
Tel: +47 91540000
Email: [email protected]
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