Costs of care and oncologic outcomes associated with blue light cystoscopy in an equal access setting: Results from the BRAVO study

Background Real-world data on the costs and outcomes of blue light cystoscopy (BLC) for non-muscle-invasive bladder cancer (NMIBC) are limited. We compared healthcare costs and oncologic outcomes associated with BLC versus white light cystoscopy only (WLC) in patients with NMIBC. Methods We performed a retrospective cohort study of NMIBC patients treated in the Veterans Affairs (VA) healthcare system between January 1, 1997 and December 31, 2021. Patients exposed to BLC after diagnosis were compared with WLC-only patients. Propensity score matching (1:1) identified 311 BLC-exposed and 311 WLC-only patients. Outcomes included 5-year total and category-specific healthcare costs, NMIBC recurrence, and recurrence-related cost offsets. Results Among 622 matched patients (311 BLC; 311 WLC), median age was 71 years, and 378 (61%) had high-risk disease. BLC-exposed patients were more likely to receive intravesical BCG (190 [61%] vs. 133 [43%]; p ' 0.01) and intravesical chemotherapy (149 [49%] vs. 86 [28%]; p ' 0.01). Unadjusted 5-year total costs were higher with BLC ($108,411 vs. $66,734; p ' 0.01), primarily due to outpatient costs ($90,788 vs. $55,529; p ' 0.01). BLC was associated with decreased risk of recurrence (HR 0.62, 95% CI 0.45 – 0.86). After accounting for recurrence-related cost offsets, the adjusted 5-year cost difference was $721 per patient. Conclusions In an equal-access setting, BLC exposure was associated with higher 5-year costs, largely driven by outpatient care. However, lower recurrence rates reduced the net cost difference, resulting in near cost neutrality. These findings highlight the trade-off between higher upfront costs and improved recurrence outcomes when incorporating BLC into NMIBC management.