背景:膀胱癌是以每个患者为基础治疗的最昂贵的癌症。在非肌肉浸润性膀胱癌(NMIBC)中,与白光膀胱镜检查(WLC)相比,使用六胺乙酰丙酸酯(BLC)的蓝光膀胱镜检查已证明诊断准确性提高。由于前期成本较高,关于长期BLC成本结果的问题仍然存在。
目的:本研究旨在从医疗保险付款人的角度探讨BLC和WLC的5年成本比较。
方法:构建了具有代表性的5年NMIBC管理模式,并覆盖了Medicare报销价值。主要结果是按每年3%的百分比率将年平均累计成本折现为现值。次要结果是临床事件的发生率。
结果:BLC队列中的患者复发较少。在累积现值成本基础上,在第1年、第2年和第3年,每位患者的BLC比WLC更昂贵,然而,在第4年和第5年,BLC在经济上是有利的。第5年BLC的平均累计成本节省为每位患者1,172美元。总的来说,在第1年,与WLC相比,BLC组中所有患者的31.6%产生了累积成本节省,而在第5年年底为50.9%。
结论:尽管初始年度成本较高,监测第3年后,BLC略有累积经济优势。此外,在第5年结束时,接受BLC的患者中更大比例实现了成本节约.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进。
BACKGROUND: 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.
OBJECTIVE: This study seeks to investigate the 5-year cost comparison of BLC and WLC from the Medicare payer perspective.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.