Scilipoti Pietro, Moschini Marco, Li Roger, Lerner Seth P, Black Peter C, Necchi Andrea, Rouprêt Morgan, Shariat Shahrokh F, Gupta Shilpa, Morgans Alicia K, Psutka Sarah P, Kamat Ashish M
Department of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
Department of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
Eur Urol. 2025 May;87(5):536-550. doi: 10.1016/j.eururo.2024.12.002. Epub 2024 Dec 26.
Bladder cancer (BCa) imposes a substantial economic burden on health care systems and patients. Understanding these financial implications is crucial for effective resource allocation and optimization of treatment cost effectiveness. Here, we aim to systematically review and analyze the financial burden of BCa from the health care and patient perspectives.
A Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-compliant systematic review was conducted, searching PubMed/Medline, Embase, and public sources for studies evaluating the financial impact of BCa, encompassing costs, cost effectiveness, and financial toxicity (FT).
Non-muscle-invasive BCa (NMIBC) incurs significant costs for surveillance and treatment, with costs exceeding $200 000 after 5 yr for high-risk NMIBC patients progressing after bacillus Calmette-Guerin (BCG) treatment (including inpatient, outpatient, and physician service expenses). Muscle-invasive BCa generates substantial costs from radical cystectomy (RC) and neoadjuvant chemotherapy, averaging $30 000-40 000 from surgical costs of RC, with additional expenses in case of complications. Trimodal therapy has higher costs (1-yr management cost >$200 000) than RC because of higher outpatient, radiology, and medication costs. Metastatic BCa incurs the highest financial burden, with systemic therapy costs ranging from $40 000 to over $100 000 per five-cycle course, increasing further with combination therapies (ie, enfortumab vedotin and pembrolizumab), treatment-related toxicity, and supportive care. FT is particularly prevalent among younger, less educated, and minority populations.
BCa treatment, particularly in advanced stages, imposes a substantial economic burden. Innovations in care, while improving oncologic outcomes, necessitate detailed cost-effectiveness assessments. Addressing these economic challenges is essential for optimizing BCa management, targeting patients at a higher risk of FT, and improving patient quality of life.
膀胱癌（BCa）给医疗保健系统和患者带来了沉重的经济负担。了解这些经济影响对于有效资源分配和治疗成本效益的优化至关重要。在此，我们旨在从医疗保健和患者角度系统地回顾和分析膀胱癌的经济负担。
进行了一项符合系统评价与Meta分析的首选报告项目（PRISMA）的系统评价，在PubMed/Medline、Embase和公共来源中检索评估膀胱癌经济影响的研究，包括成本、成本效益和经济毒性（FT）。
非肌层浸润性膀胱癌（NMIBC）的监测和治疗会产生重大成本，对于卡介苗（BCG）治疗后进展的高危NMIBC患者，5年后成本超过20万美元（包括住院、门诊和医生服务费用）。肌层浸润性膀胱癌因根治性膀胱切除术（RC）和新辅助化疗产生大量成本，RC手术成本平均为3万至4万美元，出现并发症时还会有额外费用。三联疗法的成本高于RC（1年管理成本>20万美元），因为门诊、放射学和药物成本更高。转移性膀胱癌的经济负担最高，全身治疗成本每五周期疗程从4万美元到超过10万美元不等，联合疗法（如恩沃利单抗和帕博利珠单抗）、治疗相关毒性和支持性护理会使其进一步增加。经济毒性在年轻、受教育程度较低和少数族裔人群中尤为普遍。
膀胱癌治疗，尤其是晚期治疗，会带来沉重的经济负担。护理创新在改善肿瘤学结局的同时，需要进行详细的成本效益评估。应对这些经济挑战对于优化膀胱癌管理、针对经济毒性风险较高的患者以及提高患者生活质量至关重要。
