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UPJ INSIGHT Budgetary Impact of Including Cxbladder Detect in the Evaluation of Microhematuria Patients

By: Mark D. Tyson, MD, MPH, Mayo Clinic Arizona, Phoenix; Robert Abouassaly, MD, Cleveland Clinic, Ohio; Adri Durant, MD, Mayo Clinic Arizona, Phoenix; Antonia Bosworth Smith, MS, Coreva Scientific GmbH & Co.KG, Königswinter, North Rhine-Westphalia, Germany; Kim Seemann, MS, Coreva Scientific GmbH & Co.KG, Königswinter, North Rhine-Westphalia, Germany; Daniel A. Shoskes, MD, MSc, FRCS(C), Pacific Edge Diagnostics USA, Hummelstown, Pennsylvania | Posted on: 19 Jan 2024

Tyson MD, Abouassaly R, Durant A, Smith AB, Seemann K, Shoskes DA. Budgetary impact of including the urinary genomic marker Cxbladder Detect in the evaluation of microhematuria patients. Urol Pract. 2024;11(1):53-60.

Study Need and Importance

The study investigated the financial implications of incorporating Cxbladder Detect, a urine genomic marker, into the evaluation of microhematuria patients. Current guidelines require a risk-stratified approach for microhematuria assessment, leading to invasive diagnostic procedures. Cxbladder Detect, with its high negative predictive value, could reduce unnecessary testing and costs.

What We Found

Using a decision tree model, the study revealed that implementing Cxbladder Detect resulted in an average cost savings of $559 per patient compared to the standard of care. It reduced the average number of diagnostic procedures per patient by 0.38 without affecting the number of cancers diagnosed. Probabilistic analysis confirmed the cost reduction (median $498 per patient) and diagnostic procedure reduction (median 0.36) while maintaining diagnostic accuracy. The tornado diagram (Figure) illustrates the sensitivity analysis of the deterministic model to variations in input parameters, showcasing the significant impact of a +10% and −10% change in inputs on cost savings, thereby highlighting the key factors influencing cost savings.

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Figure. Tornado diagram showing the sensitivity of the deterministic analysis to variations in input parameters and their impact on cost savings. CT indicates computed tomography; TURBT, transurethral resection of bladder tumor.

Limitations

The study’s estimates are contingent on data quality and regional uniformity, introducing some uncertainty. Long-term ramifications and real-world data validation are yet to be explored, and the model’s applicability beyond the first year warrants further investigation.

Interpretation for Patient Care

The study highlights the potential value of Cxbladder Detect in enhancing diagnostic efficiency and reducing health care costs for microhematuria patients suspected of having bladder cancer. It maintains diagnostic accuracy, offering a noninvasive alternative to invasive procedures. This approach can lead to earlier diagnoses, improved patient outcomes, and better resource allocation, benefiting both patients and health care systems.

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