{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:45:49Z","timestamp":1787013949612,"version":"build-2736575974"},"reference-count":27,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,8,29]],"date-time":"2024-08-29T00:00:00Z","timestamp":1724889600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To compare the clinical, economic, and health utility outcomes associated with alternative cystoscopic surveillance regimens for high\u2010risk non\u2010muscle\u2010invasive bladder cancer (HRNMIBC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>We performed real\u2010world clinical data\u2010driven microsimulations of a hypothetical cohort of 100\u2009000 patients diagnosed with HRNMIBC at age 70\u2009years. The cohort was simulated to undergo alternative surveillance regimens recommended by five guidelines, and two hypothetical regimens\u2014surveillance intensity escalation and de\u2010escalation\u2014which had a surveillance intensity moderately higher and lower, respectively, than the guideline\u2010recommended regimens. We evaluated the 10\u2010year cumulative incidence of muscle\u2010invasive bladder cancer (MIBC), cancer\u2010specific survival (CSS), overall survival (OS), and cost\u2010effectiveness from a United States healthcare payer perspective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The guideline\u2010recommended surveillance regimens led to an estimated 10\u2010year cumulative incidence of MIBC ranging from 11.0% to 11.6%, CSS 95.0% to 95.2%, and OS 69.7% to 69.8%. Surveillance intensity escalation resulted in a 10\u2010year cumulative incidence of MIBC of 10.5% (95% confidence interval [CI] 10.3\u201310.7%), CSS of 95.4% (95% CI 95.2\u201395.5%), and OS of 69.9% (95% CI 69.6\u201370.1%), vs 11.9% (95% CI 11.7\u201312.1%), 94.9% (95% CI 94.8\u201395.1%), and 69.6% (95% CI 69.3\u201369.9%), respectively, from surveillance intensity de\u2010escalation. By increasing surveillance intensity, the number\u2010needed\u2010to\u2010treat to prevent one additional MIBC progression over 10\u2009years was \u226580, and \u2265257 to avoid one additional cancer\u2010related mortality. Compared to surveillance intensity de\u2010escalation, higher\u2010intensity regimens incurred an incremental cost of \u2265$336\u2009000 per incremental quality\u2010adjusted life year gained, which well exceeded conventional willingness\u2010to\u2010pay thresholds, \u2265$686\u2009000 per additional MIBC progression prevented, and \u2265$2.2\u2009million per additional cancer\u2010related mortality avoided.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In microsimulations testing a wide range of cystoscopic surveillance intensity for patients newly diagnosed with HRNMIBC, moderate surveillance de\u2010escalation appears associated with an insignificant change in 10\u2010year OS and furthermore is cost\u2010effective vs higher\u2010intensity surveillance regimens. These results suggest that moderate surveillance de\u2010escalation can reduce costs of care without compromising life expectancy for many patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.16521","type":"journal-article","created":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T02:00:05Z","timestamp":1724983205000},"page":"148-155","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Varying the intensity of cystoscopic surveillance for high\u2010risk non\u2010muscle\u2010invasive bladder cancer"],"prefix":"10.1111","volume":"135","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3215-6192","authenticated-orcid":false,"given":"Zhuo Tony","family":"Su","sequence":"first","affiliation":[{"name":"The James Buchanan Brady Urological Institute Johns Hopkins University School of Medicine  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella 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