Thomas Michaeli1, Julia Michaeli2,3, Daniel Michaeli2. 1. Fifth Department of Medicine, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany. c.michaeli@yahoo.de. 2. Fifth Department of Medicine, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany. 3. Department of Obstetrics and Gynecology, Asklepios-Clinic Hamburg Altona, Asklepios Hospital Group, Hamburg, Germany.
Abstract
PURPOSE: Advances in testicular cancer screening and therapy increased 10-year survival to 97% despite a rising incidence; eventually expanding the population of survivors requiring follow-up. We analyzed 10-year follow-up costs after testicular cancer treatment in Germany during 2000, 2008, and 2015. METHODS: Testicular 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 expert interviews, literature research, and official scales of tariffs. Three perspectives covering costs for patients, providers, and insurers were included to estimate societal costs. Cost progression was compared across cancer histology, stage, stakeholders, resource use, and follow-up years. RESULTS: Mean 10-year follow-up costs per patient for stage I seminomatous germ-cell tumors (SGCT) on surveillance declined from EUR 11,995 in 2000 to EUR 4,430 in 2015 (p < 0.001). Advanced SGCT spending shrank from EUR 13,866 to EUR 9,724 (p < 0.001). In contrast, expenditure for stage II SGCT increased from EUR 7,159 to EUR 9,724 (p < 0.001). While insurers covered 32% of costs in 2000, only 13% of costs were reimbursed in 2015 (p < 0.001). 70% of SGCT follow-up resources were consumed by medical imaging (x-ray, CT, ultrasound, FDG-PET). Spending was unevenly distributed across follow-up years (years 1-2: 50%, years 3-5: 39%, years 5-10: 11%). CONCLUSIONS: The increasing prevalence of testicular cancer survivors caused German statutory insurers to cut per patient cost by up to 80% by budgeting services and decreasing reimbursement rates. The economic burden was gradually redistributed to patients and providers.
PURPOSE: Advances in testicular cancer screening and therapy increased 10-year survival to 97% despite a rising incidence; eventually expanding the population of survivors requiring follow-up. We analyzed 10-year follow-up costs after testicular cancer treatment in Germany during 2000, 2008, and 2015. METHODS:Testicular 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 expert interviews, literature research, and official scales of tariffs. Three perspectives covering costs for patients, providers, and insurers were included to estimate societal costs. Cost progression was compared across cancer histology, stage, stakeholders, resource use, and follow-up years. RESULTS: Mean 10-year follow-up costs per patient for stage I seminomatous germ-cell tumors (SGCT) on surveillance declined from EUR 11,995 in 2000 to EUR 4,430 in 2015 (p < 0.001). Advanced SGCT spending shrank from EUR 13,866 to EUR 9,724 (p < 0.001). In contrast, expenditure for stage II SGCT increased from EUR 7,159 to EUR 9,724 (p < 0.001). While insurers covered 32% of costs in 2000, only 13% of costs were reimbursed in 2015 (p < 0.001). 70% of SGCT follow-up resources were consumed by medical imaging (x-ray, CT, ultrasound, FDG-PET). Spending was unevenly distributed across follow-up years (years 1-2: 50%, years 3-5: 39%, years 5-10: 11%). CONCLUSIONS: The increasing prevalence of testicular cancer survivors caused German statutory insurers to cut per patient cost by up to 80% by budgeting services and decreasing reimbursement rates. The economic burden was gradually redistributed to patients and providers.
Entities:
Keywords:
Cost; Follow-up; Health insurance; Medical imaging; Testicular cancer
Authors: Susanne Krege; Jörg Beyer; Rainer Souchon; Peter Albers; Walter Albrecht; Ferran Algaba; Michael Bamberg; István Bodrogi; Carsten Bokemeyer; Eva Cavallin-Ståhl; Johannes Classen; Christoph Clemm; Gabriella Cohn-Cedermark; Stéphane Culine; Gedske Daugaard; Pieter H M De Mulder; Maria De Santis; Maike de Wit; Ronald de Wit; Hans Günter Derigs; Klaus-Peter Dieckmann; Annette Dieing; Jean-Pierre Droz; Martin Fenner; Karim Fizazi; Aude Flechon; Sophie D Fosså; Xavier Garcia del Muro; Thomas Gauler; Lajos Geczi; Arthur Gerl; Jose Ramon Germa-Lluch; Silke Gillessen; Jörg T Hartmann; Michael Hartmann; Axel Heidenreich; Wolfgang Hoeltl; Alan Horwich; Robert Huddart; Michael Jewett; Johnathan Joffe; William G Jones; László Kisbenedek; Olbjørn Klepp; Sabine Kliesch; Kai Uwe Koehrmann; Christian Kollmannsberger; Markus Kuczyk; Pilar Laguna; Oscar Leiva Galvis; Volker Loy; Malcolm D Mason; Graham M Mead; Rolf Mueller; Craig Nichols; Nicola Nicolai; Tim Oliver; Dalibor Ondrus; Gosse O N Oosterhof; Luis Paz-Ares; Giorgio Pizzocaro; Jörg Pont; Tobias Pottek; Tom Powles; Oliver Rick; Giovanni Rosti; Roberto Salvioni; Jutta Scheiderbauer; Hans-Ulrich Schmelz; Heinz Schmidberger; Hans-Joachim Schmoll; Mark Schrader; Felix Sedlmayer; Niels E Skakkebaek; Aslam Sohaib; Sergei Tjulandin; Padraig Warde; Stefan Weinknecht; Lothar Weissbach; Christian Wittekind; Eva Winter; Lori Wood; Hans von der Maase Journal: Eur Urol Date: 2007-12-26 Impact factor: 20.096
Authors: Susanne Krege; Jörg Beyer; Rainer Souchon; Peter Albers; Walter Albrecht; Ferran Algaba; Michael Bamberg; István Bodrogi; Carsten Bokemeyer; Eva Cavallin-Ståhl; Johannes Classen; Christoph Clemm; Gabriella Cohn-Cedermark; Stéphane Culine; Gedske Daugaard; Pieter H M De Mulder; Maria De Santis; Maike de Wit; Ronald de Wit; Hans Günter Derigs; Klaus-Peter Dieckmann; Annette Dieing; Jean-Pierre Droz; Martin Fenner; Karim Fizazi; Aude Flechon; Sophie D Fosså; Xavier Garcia del Muro; Thomas Gauler; Lajos Geczi; Arthur Gerl; Jose Ramon Germa-Lluch; Silke Gillessen; Jörg T Hartmann; Michael Hartmann; Axel Heidenreich; Wolfgang Hoeltl; Alan Horwich; Robert Huddart; Michael Jewett; Johnathan Joffe; William G Jones; László Kisbenedek; Olbjørn Klepp; Sabine Kliesch; Kai Uwe Koehrmann; Christian Kollmannsberger; Markus Kuczyk; Pilar Laguna; Oscar Leiva Galvis; Volker Loy; Malcolm D Mason; Graham M Mead; Rolf Mueller; Craig Nichols; Nicola Nicolai; Tim Oliver; Dalibor Ondrus; Gosse O N Oosterhof; Luis Paz Ares; Giorgio Pizzocaro; Jörg Pont; Tobias Pottek; Tom Powles; Oliver Rick; Giovanni Rosti; Roberto Salvioni; Jutta Scheiderbauer; Hans-Ulrich Schmelz; Heinz Schmidberger; Hans-Joachim Schmoll; Mark Schrader; Felix Sedlmayer; Niels E Skakkebaek; Aslam Sohaib; Sergei Tjulandin; Padraig Warde; Stefan Weinknecht; Lothar Weissbach; Christian Wittekind; Eva Winter; Lori Wood; Hans von der Maase Journal: Eur Urol Date: 2007-12-26 Impact factor: 20.096