The current standard of care in the United States calls for continued monitoring after resection, requiring frequent cystoscopic examinations. Patients with frequently recurring non-muscle-invasive urothelial cancer face weekly intravesical instillations of chemotherapy or immunotherapy to reduce the likelihood of recurrence.

“Because of long-term survival and the need for lifelong routine monitoring and treatment, the cost per patient of bladder cancer from diagnosis to death is the highest of all cancers, ranging from 96,000 to 187,000 US dollars (2001 values) in the United States,” a 2003 economic analysis reported. “Overall, bladder cancer is the fifth most expensive cancer in terms of total medical care expenditures, accounting for almost 3.7 billion US dollars (2001 values) in direct costs in the United States.” 2

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Plus, an aging population contributes to an increasing number of cases diagnosed per year ― with nearly 80,000 new cases reported in 2017.

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Therefore, the authors of an editorial accompanying Dr Messing’s study wrote, the gemcitabine research has “potentially practice-changing implications.

“Given the potential benefits of these findings, it will be important to educate and mobilize patients with bladder cancer, physicians, advocacy organizations, and health system leaders to facilitate diffusion of this simple, safe, effective, and affordable innovation in the treatment of bladder cancer.” 3


  1. Messing EM, Tangen CM, Lerner SP, et al. Effect of intravesical instillation of gemcitabine vs saline immediately following resection of suspected low-grade non–muscle-invasive bladder cancer on tumor recurrence: SWOG S0337 randomized clinical trialJAMA. 2018;319(18):1880-1888. doi: 10.1001/jama.2018.4657
  2. Botteman  MF, Pashos  CL, Redaelli  A, Laskin  B, Hauser  R. The health economics of bladder cancer: a comprehensive review of the published literaturePharmacoeconomics. 2003;21(18):1315-1330.
  3. Kaffenberger SD, Miller DC, Nielsen ME. Simplifying treatment and reducing recurrence for patients with early-stage bladder cancerJAMA. 2018;319(18):1864-1865. doi: 10.1001/jama.2018.4656