Bladder cancer is often diagnosed before tumours have invaded the muscle of the bladder wall or spread to other organs. This early-stage disease is called non-muscle-invasive bladder cancer. It can be treated effectively with surgical resection (removal) of the tumours. To prevent the tumours from coming back, it is important that all tumours be completely removed at this early stage of the disease.

Standard treatment for early-stage bladder cancer is a procedure called transurethral resection of bladder tumour, or TURBT. In this treatment, the surgeon uses a cystoscope – a tube equipped with a light source and a lens – to find and remove tumours. Conventionally, TURBT is done using white light. However, small or flat tumours can be missed under white light. To improve outcomes after first TURBT, new technologies for detecting tumours have been developed. Two of these technologies are available in Canada. One is known as HAL (short for hexaminolevulinate hydrochloride), a solution put into the bladder to make tumours glow under blue–violet light. The other is narrow band imaging, a technology that filters white light into wavelengths that make tumours more visible.

This health technology assessment looked at the safety, effectiveness, and cost-effectiveness of using HAL and narrow band imaging in addition to white light during first TURBT for people with suspected non-muscle-invasive bladder cancer. It also looked at the budget impact of publicly funding HAL and narrow band imaging to help guide first TURBTs for these people.