Socio-economic burden of disease: Survivorship costs for bladder cancer

Background: 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. Methods: 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. Results: 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%). Conclusions: 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.