Avritscher Elenir B C, Cooksley Catherine D, Grossman H Barton, Sabichi Anita L, Hamblin Lois, Dinney Colin P, Elting Linda S
Section of Health Services Research, Department of Biostatistics and Applied Mathematics, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Urology. 2006 Sep;68(3):549-53. doi: 10.1016/j.urology.2006.03.062. Epub 2006 Sep 18.
To estimate the lifetime cost of bladder cancer and the contribution of complications to the total costs.
We reviewed the medical records of a retrospective cohort of 208 patients with bladder cancer who registered at our comprehensive cancer center from 1991 to 1999. We multiplied the number of resources used during management of bladder cancer by their unit charges. We converted charges into costs using the Medicare cost-to-charge ratio and inflated these to 2005 U.S. dollars. We estimated future costs by creating two extreme hypothetical scenarios. In the best-case scenario, we assumed patients with superficial disease developed recurrences at the cohort's mean rate and that patients with muscle-invasive disease were disease free after definitive therapy. Survival was based on the U.S. life expectancy in both cases. In the worst-case scenario, we assumed patients with superficial disease developed muscle-invasive disease and that all patients subsequently died of bladder cancer.
The average cost of bladder cancer was 65,158 dollars among the cohort patients. Sixty percent of this cost (39,393 dollars) was associated with surveillance and treatment of recurrences, and 30% (19,811 dollars) was attributable to complications. The lifetime cost of bladder cancer was lower for the worst-case scenario (99,270 dollars) than for the best-case scenario (120,684 dollars). However, a greater proportion of the costs were attributable to complications with the worst-case scenario (43%, 42,290 dollars) compared with the best (28%, 34,169 dollars).
The management of bladder cancer and its associated complications results in a major economic burden. More cost-effective surveillance strategies and approaches for preventing complications are crucial to minimizing the disease's clinical and economic consequences.
估算膀胱癌的终生成本以及并发症对总成本的贡献。
我们回顾了1991年至1999年在我们综合癌症中心登记的208例膀胱癌患者的回顾性队列的病历。我们将膀胱癌管理期间使用的资源数量乘以其单位费用。我们使用医疗保险成本与收费比率将收费转换为成本，并将这些成本膨胀至2005年的美元价值。我们通过创建两种极端假设情景来估算未来成本。在最佳情景中，我们假设浅表性疾病患者以队列的平均复发率复发，而肌肉浸润性疾病患者在确定性治疗后无疾病。两种情况下的生存均基于美国预期寿命。在最坏情景中，我们假设浅表性疾病患者发展为肌肉浸润性疾病，并且所有患者随后死于膀胱癌。
队列患者中膀胱癌的平均成本为65,158美元。其中60%（39,393美元）与复发的监测和治疗相关，30%（19,811美元）归因于并发症。膀胱癌的终生成本在最坏情景（99,270美元）下低于最佳情景（120,684美元）。然而，与最佳情景（28%，34,169美元）相比，最坏情景中更大比例的成本归因于并发症（43%，42,290美元）。
膀胱癌及其相关并发症的管理导致重大经济负担。更具成本效益的监测策略和预防并发症的方法对于将该疾病的临床和经济后果降至最低至关重要。
