Fifth Department of Medicine, University Hospital Mannheim, Heidelberg University, Mannheim, Germany; Department of Obstetrics and Gynecology, Asklepios-Clinic Hamburg-Altona, Asklepios Hospital Group, Hamburg, Germany.
Department of Personalized Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany; Division of Personalized Medical Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Third Department of Medicine, University Hospital Mannheim, Heidelberg University, Mannheim, Germany.
J Cancer Policy. 2022 Jun;32:100326. doi: 10.1016/j.jcpo.2022.100326. Epub 2022 Feb 9.
In this cost-of-illness study, we analysed the socio-economic burden of bladder cancer survivorship for the ten years after initial treatment in Germany during 2000, 2010 and 2020.
Bladder cancer follow-up guidelines were extracted from the European Association of Urology. Per patient costs were estimated with a micro-costing approach considering direct and indirect medical expenses derived from literature and official scales of tariffs. Three perspectives covering costs for patients, providers, and insurers were included to estimate societal costs.
Mean 10-year follow-up costs per patient amounted to EUR 2214 for low-risk, EUR 4758 for medium-risk, and EUR 11,325 for high-risk non-muscle invasive bladder cancer (NMIBC) in 2020. The mean economic burden of muscle-invasive and metastatic bladder cancer (MIBC) was EUR 8994 per patient. Overall expenditure rose by 65% from 2000 to 2020 across all cancer stages (p < 0.001). While insurers covered 38% of costs in 2000, only 31% of costs were reimbursed in 2020 (p < 0.001). 58% of high-risk NMIBC follow-up resources were consumed by physician-patient visits and 17% by medical imaging (x-ray, CT-IVU, ultrasound). Spending was unevenly distributed across follow-up years (years 1-2: 43%, years 3-5: 29%, years 5-10: 28%).
The rising socio-economic burden of follow-ups signifies the relevance of cancer survivorship for the healthcare system and society. This burden must be evenly distributed across stakeholders and considered in cost-effectiveness evaluations of novel anti-cancer drugs. Policy summary Personalized, equitable, and effective follow-up schedules covered by insurance funds are necessary to care for cancer survivors.
在这项疾病成本研究中，我们分析了 2000 年、2010 年和 2020 年德国初始治疗后 10 年内膀胱癌生存者的社会经济负担。
从欧洲泌尿外科学会提取膀胱癌随访指南。采用微观成本法，根据文献和官方费率表，估算每位患者的直接和间接医疗费用。从患者、提供者和保险公司三个角度估算社会成本。
2020 年，低危非肌层浸润性膀胱癌（NMIBC）患者 10 年平均随访费用为 2214 欧元，中危患者为 4758 欧元，高危患者为 11325 欧元。肌层浸润性和转移性膀胱癌（MIBC）患者的平均经济负担为 8994 欧元/人。2000 年至 2020 年，所有癌症阶段的总支出增长了 65%（p<0.001）。2000 年，保险公司承担了 38%的费用，而 2020 年仅报销了 31%的费用（p<0.001）。高危 NMIBC 随访资源的 58%用于医患就诊，17%用于医学影像学（X 光、CT-IVU、超声）。支出在随访年分布不均（第 1-2 年：43%，第 3-5 年：29%，第 5-10 年：28%）。
随访带来的社会经济负担不断增加，表明癌症生存者对医疗保健系统和社会的重要性。这种负担必须在利益相关者之间平均分配，并在新抗癌药物的成本效益评估中考虑。
个性化、公平和有效的保险基金覆盖的随访计划对于癌症幸存者的护理是必要的。
