Advancing Bladder Cancer Care: BRAVO Study on Surveillance Technologies and Cost-Effectiveness

The BRAVO study found a 38% relative reduction in non-muscle-invasive bladder cancer (NMIBC) recurrence (HR 0.62; p<0.01) with blue light cystoscopy (BLC) versus white light cystoscopy (WLC) and reported five‑year cost neutrality despite higher up‑front costs.

WLC frequently misses occult or flat lesions, contributing to high recurrence rates and downstream morbidity in high‑risk NMIBC. Missed lesions drive repeat resections, increased intravesical therapy use, and more acute presentations that burden patients and systems. By reducing recurrence, the BRAVO findings shift the benefit–cost calculus toward BLC and align with both patient- and system-level priorities.

Cost neutrality in BRAVO reflects higher initial per‑procedure and equipment costs for BLC that were offset over five years by avoided recurrence‑related procedures, shorter hospital stays, fewer emergency visits, and lower aggregate treatment costs. The model’s principal levers were recurrence rate, cost per recurrence event, emergency visit frequency, and the five‑year horizon, producing near‑equivalent net costs between strategies.

Patients with high‑risk NMIBC—carcinoma in situ (CIS), multifocal disease, or high‑grade tumors—stand to gain most from BLC through improved lesion detection and earlier initiation of guideline intravesical therapy.