The rising cost of cancer care is a growing concern for health systems. A 2020 study estimated Europe’s annual cancer-related expenditure at €199 billion, with €109 billion attributed to healthcare costs. Bladder cancer (BC), in particular, imposes a significant financial burden. Despite a relatively low mortality-to-incidence ratio, BC remains one of the most expensive cancers to manage due to high treatment and follow-up demands. Health spending on BC has outpaced incidence, highlighting inefficiencies in current care models. Urologists, who are typically the first point of contact for BC patients, play a key role in optimising treatment and follow-up decisions to ensure effective yet resource-conscious care. As outlined by Scilipoti et al. in European Urology, costs are highest in advanced BC due to expensive therapies and eventual palliative care. Innovations such as patient-derived organoids (PDOs) and circulating tumour DNA can help personalise treatment, improve response monitoring, and avoid ineffective therapies. For muscle-invasive BC, strategies like minimally invasive surgery, enhanced recovery protocols, and biomarker-guided adjuvant therapy can reduce costs without sacrificing outcomes. However, non–muscle-invasive BC (NMIBC) drives the bulk of financial and emotional burden due to frequent recurrences and intensive follow-up. Improving the quality of initial transurethral resection (TURBT) and using photodynamic diagnosis can delay recurrence and guide more precise follow-up. Routine cystoscopy schedules for NMIBC may be excessive. Studies suggest that, particularly for low- and intermediate-risk tumours, urinary biomarkers and ultrasound could safely reduce the frequency of cystoscopies. Decentralising follow-up from hospitals to outpatient clinics could further lower indirect costs. Finally, artificial intelligence offers promise for improving early detection, treatment planning, and shared decision-making. The insights from Scilipoti et al. underscore the need for innovation and policy reform to manage BC effectively while containing costs.
The cost of bladder cancer: what can be done?
Reviewed by Asif H Ansari
The cost of bladder cancer: what can be done?
