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      We
      • Al Hussein Al Awamlh B.
      • Lee R
      • Chughtai B.
      • et al.
      A cost-effectiveness analysis of management of low-risk non–muscle-invasive bladder cancer using office-based fulguration.
      agree that the quality and results of a cost-effectiveness study are only as good as the data and assumptions used in the model. In our study, for instance, we extrapolated utility data for office fulguration using data from other endoscopic procedures and assumed recurrence rates based on a well-regarded meta-analysis.
      • Sylvester R.J.
      • Oosterlinck W.
      • van der Meijden A.P.
      A single immediate postoperative instillation of chemotherapy decreases the risk of recurrence in patients with stage Ta T1 bladder cancer: a meta-analysis of published results of randomized clinical trials.
      We performed sensitivity analyses to provide a perspective on outcomes if these assumptions were varied. Office-based fulguration is more cost effective than operating room–based transurethral resection of the bladder.
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      References

        • Al Hussein Al Awamlh B.
        • Lee R
        • Chughtai B.
        • et al.
        A cost-effectiveness analysis of management of low-risk non–muscle-invasive bladder cancer using office-based fulguration.
        Urology. 2015; 85: 381-387
        • Sylvester R.J.
        • Oosterlinck W.
        • van der Meijden A.P.
        A single immediate postoperative instillation of chemotherapy decreases the risk of recurrence in patients with stage Ta T1 bladder cancer: a meta-analysis of published results of randomized clinical trials.
        J Urol. 2004; 171 (quiz 2435): 2186-2190
        • Banthin J.S.
        • Bernard D.M.
        Changes in financial burdens for health care: national estimates for the population younger than 65 years, 1996 to 2003.
        JAMA. 2006; 296: 2712-2719
        • Botteman M.F.
        • Pashos C.L.
        • Redaelli A.
        • et al.
        The health economics of bladder cancer: a comprehensive review of the published literature.
        PharmacoEconomics. 2003; 21: 1315-1330

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      • Editorial Comment
        UrologyVol. 85Issue 2
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          Reducing health care costs has long been a priority for payers and policymakers for at least 2 reasons. First and foremost, perpetuating historical trends in spending growth would be incompatible with a healthy economy. Second, there is increasing recognition that the US health care system is inefficient, exemplified by productivity gains in the United States lagging behind those of comparable nations that spend far less per capita. Indeed, even American professional organizations have acknowledged as much, evidenced by the American Board of Internal Medicine's “Choosing Wisely” campaign.
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