Can we still afford bladder cancer?

摘要

PURPOSE OF REVIEW: Bladder cancer is the most expensive tumor with regard to both costs per patient per year and lifetime costs per patient. Nonmuscle invasive tumors account for the highest share of the overall costs for bladder cancer. Costs for follow-up (excluding costs for reinterventions) compared with transurethral resection and cystectomy account for a considerably lower portion of the overall costs. RECENT FINDINGS: From an economic standpoint, the biggest potential for savings could, therefore, be in the treatment and re-treatment of nonmuscle invasive tumors. Cost reductions have already been demonstrated with a reduction of hospital admission for such treatments, use of photodynamic diagnosis supported transurethral resection to avoid residual tumors, and adjuvant chemoinstillation and immunoinstillation to prolong or prevent tumor recurrences. SUMMARY: Further cost reductions can be achieved with a centralization of patients undergoing cystectomy by shifting these patients to high-volume surgeons in high-volume hospitals, thereby reducing complications and length of hospital stay. In advanced stages predictive markers may identify suitable subgroups for molecular therapies and, therefore, avoid costs of inappropriate treatments.