Creswell Michael L, Sholklapper Tamir N, Markel Michael J, Mason James B, Pianka Mark A, Dall Christopher P, Ulu Canan, Stamatakis Lambros
Georgetown University School of Medicine, Washington, DC, USA.
Georgetown University McDonough School of Business, Washington, DC, USA.
Bladder Cancer. 2023 Mar 31;9(1):87-96. doi: 10.3233/BLC-220027. eCollection 2023.
Bladder cancer is the most expensive cancer to treat on a per-patient basis. Blue light cystoscopy with hexaminolevulinate (BLC) has demonstrated improved diagnostic accuracy compared with white light cystoscopy (WLC) in non-muscle invasive bladder cancer (NMIBC). With higher upfront costs, questions remain about long-term BLC cost outcomes.
This study seeks to investigate the 5-year cost comparison of BLC and WLC from the Medicare payer perspective.
A representative 5-year NMIBC management model was constructed and Medicare reimbursement values were overlaid. The primary outcome was mean year-over-year cumulative cost discounted to present value at a 3% annual percentage rate. The secondary outcome was the rate of clinical events.
Patients in the BLC cohort experienced fewer recurrences. On a cumulative present value cost basis, BLC was more expensive per patient in years 1, 2, and 3 than WLC, however, in years 4 and 5, BLC was economically favorable. Year 5 BLC mean cumulative cost savings was $1,172 per patient. Overall, 31.6% of all patients in the BLC group generated cumulative cost savings compared to WLC at year 1 compared with 50.9% at the end of year 5.
Despite a higher initial annual cost, a slight cumulative economic advantage of BLC is realized after surveillance year 3. Additionally, a greater proportion of patients who received BLC achieved cost savings at the end of year 5. As novel technology emerges, economic models can help health care systems predict associated costs and quality improvements.
膀胱癌是按每位患者计算治疗费用最高的癌症。与白光膀胱镜检查（WLC）相比，使用六氨基乙酰丙酸的蓝光膀胱镜检查（BLC）在非肌层浸润性膀胱癌（NMIBC）中已显示出更高的诊断准确性。由于前期成本较高，BLC的长期成本效益仍存在疑问。
本研究旨在从医疗保险支付方的角度调查BLC和WLC的5年成本比较。
构建了一个具有代表性的5年NMIBC管理模型，并叠加了医疗保险报销价值。主要结果是按3%的年百分比利率折现至现值的平均逐年累积成本。次要结果是临床事件发生率。
BLC队列中的患者复发次数较少。在累积现值成本基础上，BLC在第1、2和3年每位患者的成本比WLC更高，然而，在第4和5年，BLC在经济上更具优势。第5年BLC的平均累积成本节省为每位患者1172美元。总体而言，与WLC相比，BLC组在第1年有31.6%的患者实现了累积成本节省，而在第5年末这一比例为50.9%。
尽管初始年度成本较高，但在第3年监测期后BLC实现了轻微的累积经济优势。此外，在第5年末，接受BLC治疗的患者中有更大比例实现了成本节省。随着新技术的出现，经济模型可以帮助医疗保健系统预测相关成本和质量改善情况。
