Expert comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

Three experts were familiar with or had used this technology before.

Level of innovation

All expert commentators considered the technology to be innovative compared with standard of care. One expert thought that this would be an alternative treatment option particularly for people whose disease did not respond to Bacille Calmette‑Guérin (BCG) treatment. The experts described other technologies to assist chemotherapy such as the COMBAT BRS system (offering passive hyperthermia) and electromotive drug administration (EMDA). They noted that these technologies use different methods of heating or improving drug delivery but data on the effectiveness of these technologies remain unclear.

Potential patient impact

The main benefit identified by 3 experts is the potential of less invasive treatment for non-muscle-invasive bladder cancer in people whose cancer does not respond to, or who cannot tolerate, BCG. All experts agreed that these people were most likely to benefit from the technology. The experts noted that patients may need cystectomy when BCG has not worked, which is major surgery. Synergo could avoid a more invasive procedure and improve overall treatment experience. However, Synergo would not be suitable for all people whose disease has not responded to BCG.

Potential system impact

The experts generally agreed that the technology could reduce the number of cystectomies and reduce the need for hospital stay. Synergo could move treatment from inpatient to outpatient clinics. The cost impact of using Synergo is uncertain. One expert explained that Synergo used as first-line treatment was likely to be more expensive than standard care such as mitomycin C, for people with intermediate-risk non-muscle-invasive bladder cancer or BCG for high-risk non-muscle-invasive bladder cancer. But, Synergo may be cost saving compared with standard care in some people when BCG has not worked. Another expert suggested that Synergo could be more expensive if there was no improvement in disease-free survival. It was likely to be cost neutral or even cost saving if there was a reduced recurrence and progression. One expert noted that space would be needed to store the Synergo device. All experts thought that healthcare professionals would need training to give the treatment.

General comments

The experts thought that Synergo would be used as an alternative treatment to BCG in people with high-risk non-muscle-invasive bladder cancer. Two experts were not aware of any safety issues, but 1 commentator suggested the possibility of local toxicity using Synergo. The main barrier to adoption identified by 2 commentators was the technology cost.